Morphologic Characteristics of Hepatocellular Carcinoma in Patients with more than 5 Year-Survival

ABSTRACT

PURPOSE: To determine which morphologic and radiologic characteristics and common features of HCC in patients with a survival time of more than five years are useful for prognosis and appropriate therapeutic modality. MATERIALS AND METHODS: Among 178 patients in whom HCC was diagnosed at our hospital and who underwent dynamic CT and angiography, we retrospectively reviewed the cases of 12 who survived more than five years. Initially, the gross finding, size, number, vascularity of HCC, and extent of portal vein invasion were analyzed. The presence of lymph node enlargement was investigated during follow-up study and in cases confirmed surgically, the results were compared with the histopathologic findings. The therapeutic modalities of the 12 patients were as follows; only surgical resection, 3 cases(1 case re-operation); surgical resection with transarterial chemoembolization(TAE), 5 cases(1 case re-operation); only TAE, 4 cases (1 case combined with hollium in-jection); and at present, expiry after survival for more than five years, 3 cases; survival with disease, 3 cases and survival without disease, 6 cases(2 cases re-operation after recurrence). RESULTS: In 12 patients who survived more than five years, initial gross classification was single nodular type in 11 cases and massive type in one case; all showed typical ypervascularity on dynamic CT and hepatic angiography. With regard to extent of portal vein invasion, two cases showed involvement of the lobar branch and in one case invasion of the segmental branch was noted. In the other nine cases there was either invasion of the distal small branch or no definite portal vein invasion. HCC size ranged from 2 to 10 (mean, 5)cm. In eight cases involving surgical resection (reoperation two cases), the histopathologic findings indicated, pre-dominantly, the trabecular type and Edmondson grade II -III. The exception was one case of grade III -IV. In eight cases of single HCC at the time of diagnosis, multiple recurrent HCCs were present. In four cases tumors did not recur, and follow-up study revealed no lymph node enlargement. CONCLUSION: Initial radiologic findings [number of tumors (one only), gross classification (nodular type), vascu-larity(hypervascularity), portal vein invasion(lesser extent), histopathologic findings(predominantly trabecular type)] and the absence of lymph node enlargement are thought to be more important factors than tumor size in the prognosis of HCC. If initial examination of HCC reveals the above mentioned radiologic features, a more aggressive and active therapeutic management approach should be carefully considered.