The role of macroscopic classification in nodular-type hepatocellular carcinoma

Background: Little has been reported on the role of macroscopic classificat ion of hepatocellular carcinoma (HCC). We hypothesized that macroscopic cla ssification of HCC might have a strong correlation with long-term prognosis after hepatectomy. Methods: Four hundred and four patients with a macroscopically nodular type of HCC who underwent a hepatectomy were studied. The patients were divided into three groups: single nodular (SN) group (n = 312); single nodular wit h extranodular growth (SNEG) group (n 52); and confluent multinodular (CMN) group (n = 40). Clinicopathological variables were compared among the thre e groups. The patient survival rate was also compared among the three group s. Finally, a multivariate analysis was performed to clarify the independen t significant variables of the long-term prognosis. To confirm the consiste ncy of the results in small-size HCC, the same analyses were made using pat ients whose tumor size was equal to or less than 3 cm in diameter. Results: The alpha -fetoprotein value, tumor size, and rate of absolute non curative operation in the SNEG group were higher than in other groups, The positive rate of both portal vein invasion of cancer cells and intrahepatic metastasis in the SN group was lower than those in other groups. The rate of poorly differentiated histology in the SN group was lower than in the ot her groups. Patient survival in the SNEG group was worst among the three gr oups, However, patient survival showed no significant difference between th e SN and C groups. The MN multivariate analysis showed that the presence of intrahepatic metastasis, the macroscopic classification of SNEG type, and absolute noncurative operation were independent poor prognostic indicators. The results for patients with small HCCs measuring equal to or less than 3 cm in diameter were quite similar to the results for the other patients. Conclusions: Among the three subtypes of macroscopically nodular type of HC Cs, the SNEG type showed higher rates of portal vein invasion of cancer cel ls, intrahepatic metastasis, and poorly differentiated histology. The patie nt survival rate in the SNEG type was worst, and the SNEG type was an indep endent poor prognostic indicator. The macroscopic classification of HCC, es pecially the SNEG type, helps predict the long-term outcome after hepatecto my. (C) 2001 Excerpta Medica, Inc. All rights reserved.