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Hepatology. 2018 Jul;68(1):103-112. doi: 10.1002/hep.29762. Epub 2018 May 9.

Macrotrabecular-massive hepatocellular carcinoma: A distinctive histological subtype with clinical relevance.

Author information

1
Service d'anatomie pathologique, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Bondy, France.
2
Unité Mixte de Recherche 1162, Génomique Fonctionnelle des Tumeurs Solides, Institut National de la Santé et de la Recherche Médicale, Université Paris Descartes, Université Paris Diderot, Paris, France.
3
Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France.
4
Assistance Publique-Hôpitaux de Paris, Service d'Anatomie et de Cytologie Pathologiques, Hôpital Universitaire Beaujon; INSERM, Université Paris Diderot, CNRS, Centre de Recherche sur l'Inflammation (CRI), Paris, Département Hospitalo-Universitaire (DHU) UNITY, Clichy, France.
5
Inserm, U955, Team 18, Université Paris-Est Créteil, Faculté de Médecine.
6
Assistance Publique-Hôpitaux de Paris, Service d'Hépatologie, CHU Henri Mondor.
7
Assistance Publique-Hôpitaux de Paris, Département de Chirurgie Digestive et Hépato-Biliaire, CHU Henri Mondor, Créteil, France.
8
Service d'Hépatologie, Groupe hospitalier Paris-Seine-Saint Denis, Hôpital Jean Verdier, AP-HP, Bondy, France.
9
Hépato-gastroentérologie et oncologie digestive, Centre Hospitalier Universitaire d'Angers, Angers, France.
10
Service d'Anatomie et de Cytologie Pathologiques, Centre Hospitalier Universitaire d'Angers, Angers, France.
11
Assistance Publique-Hôpitaux de Paris, Service d'Hépatologie, Hôpital Universitaire Beaujon, France.
12
Hépato-gastroentérologie et oncologie digestive, Centre Hospitalier Universitaire de Montpellier, Montpellier, France.
13
Service d'Anatomie et de Cytologie Pathologiques, Centre Hospitalier Universitaire de Montpellier, Montpellier, France.
14
Clinique Universitaire d'Hépato-gastroentérologie, Pôle Digidune, CHU Grenoble Alpes; Université Grenoble Alpes; Institute for Advanced Biosciences-Inserm U1209/CNRS UMR 5309/Université de Grenoble-Alpes, Grenoble, France.
15
Assistance Publique-Hôpitaux de Paris, Service de Radiologie, CHU Henri Mondor, Créteil, France.
16
Service de Radiologie, Centre Hospitalier Universitaire de Montpellier, Montpellier, France.
17
Service de Radiologie, APHP, Hôpital Beaujon, Clichy, France.
18
Service de Radiologie, Centre Hospitalier-Universitaire d'Angers, Angers, France.
19
Assistance Publique-Hôpitaux de Paris, Département de Pathologie, Hôpital Henri Mondor, Créteil, France.
20
Centre de ressources biologiques BB-0033-00027, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris.
21
Assistance Publique-Hôpitaux de Paris, Service de Radiologie, Hôpital Jean Verdier, Bondy, France.

Abstract

We recently identified a histological subtype of hepatocellular carcinoma (HCC), designated as "macrotrabecular-massive" (MTM-HCC) and associated with specific molecular features. In order to assess the clinical relevance of this variant, we investigated its prognostic value in two large series of patients with HCC treated by either surgical resection or radiofrequency ablation (RFA). We retrospectively included 237 HCC surgical samples and 284 HCC liver biopsies from patients treated by surgical resection and RFA, respectively. Histological slides were reviewed by pathologists specialized in liver disease, and the MTM-HCC subtype was defined by the presence of a predominant (>50%) macrotrabecular architecture (more than six cells thick). The main clinical and biological features were recorded at baseline. Clinical endpoints were early and overall recurrence. The MTM-HCC subtype was identified in 12% of the whole cohort (16% of surgically resected samples, 8.5% of liver biopsy samples). It was associated at baseline with known poor prognostic factors (tumor size, alpha-fetoprotein level, satellite nodules, and vascular invasion). Multivariate analysis showed that MTM-HCC subtype was an independent predictor of early and overall recurrence (surgical series: hazard ratio, 3.03; 95% confidence interval, 1.38-6.65; P = 0.006; and 2.76; 1.63-4.67; P < 0.001; RFA series: 2.37; 1.36-4.13; P = 0.002; and 2.19; 1.35-3.54; P = 0.001, respectively). Its prognostic value was retained even after patient stratification according to common clinical, biological, and pathological features of aggressiveness. No other baseline parameter was independently associated with recurrence in the RFA series.

CONCLUSION:

The MTM-HCC subtype, reliably observed in 12% of patients eligible for curative treatment, represents an aggressive form of HCC that may require more specific therapeutic strategies. (Hepatology 2018;68:103-112).

PMID:
29281854
DOI:
10.1002/hep.29762
[Indexed for MEDLINE]

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