Association of tumor morphology with long-term prognosis after liver resection for patients with a solitary huge hepatocellular carcinoma—a multicenter propensity score matching analysis
Xin‐Fei Xu, Han Wu, Ju‐Dong Li, Lan‐Qing Yao, Bin Huang, Yong‐Kang Diao, Ting‐Hao Chen, Wei‐Min Gu, Zhong Chen, Jie Li, Yaoming Zhang, Hong Wang, Yingjian Liang, Ya-Hao Zhou, Chao Li, Ming-Da Wang, Cheng-Wu Zhang, Timothy M. Pawlik, Wan Yee Lau, Feng Shen, Tian Yang
Abstract
Background: A solitary hepatocellular carcinoma (HCC) without macrovascular invasion and distant metastasis, regardless of tumor size, is currently classified as early-stage disease by the latest Barcelona Clinic Liver Cancer (BCLC) staging system. While the preferred treatment is surgical resection, the association of tumor morphology with long-term survival outcomes after liver resection for a solitary huge HCC of ≥10 cm has not been defined. Methods: Patients who underwent curative liver resection for a solitary huge HCC were identified from a multicenter database. Preoperative imaging findings were used to define spherical- or ellipsoidal-shaped lesions with smooth edges as balloon-shaped HCCs (BS-HCCs); out-of-shape lesions or lesions of any shape with matt edges were defined as non-balloon-shaped HCCs (NBS-HCCs). The two groups of patients with BS-HCCs and NBS-HCCs were matched in a 1:1 ratio using propensity score matching (PSM). Clinicopathologic characteristics, long-term overall survival (OS) and recurrence-free survival (RFS) were assessed. Results: 6.4 months, P=0.015). Multivariate analyses identified BS-HCC as independently associated with better OS (HR =0.592, P=0.009) and RFS (HR =0.633, P=0.013). Conclusions: For a solitary huge HCC, preoperative imaging on tumor morphology was associated with prognosis following resection. In particular, patients with BS-HCCs had better long-term survival following liver resection versus patients with large NBS-HCCs.