Morphophenotypic Classification of Hepatocellular Carcinoma

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Morphophenotypic Classification of Hepatocellular Carcinoma

Quinta, 04.06.2020

Os critérios atualmente existentes para a avaliação do carcinoma hepatocelular (CHC) estão ainda longe do desejável por forma a instituir uma medicina individualizada. Nos últimos anos algumas classificações morfofenotípicas têm surgido na literatura. Neste trabalho comparamos duas dessas classificações e concluímos que a proposta por Tsujikawa et al, que preconiza a classificação do CHC em subtipo biliar/stem cells, é reprodutível na nossa realidade e facilmente aplicável, com impacto na sobrevivência global dos doentes com CHC, especialmente nos submetidos a hepatectomia parcial, podendo ser utilizada para referenciar doentes que beneficiem de transplante hepático.


Rui Caetano Oliveira,MD1,2,3 & Ricardo Martins,MD2,3,4,5,6 & Ana Margarida Abrantes,MSc, PhD2,3 & Ângela Jesus, MSc1 & Paulo Teixeira, MSc1 & Carolina Canhoto, MD4 & Pedro Guerreiro, MD4 & Beatriz Costa, MD, PhD3,4,5 & Mário Rui Silva, MD1 & José Guilherme Tralhão, MD, PhD4,5,6 & Maria Augusta Cipriano, MD1

1 Serviço de Anatomia Patológica, Pathology Department, Centro Hospitalar e Universitário de Coimbra, Piso-3, Praceta Mota Pinto, 3000-075 Coimbra, Portugal

2 Biophysics Institute, Faculty of Medicine, University of Coimbra, Coimbra, Portugal

3 Coimbra Institute for Clinical and Biomedical Research (iCBR) Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal

4 Surgery Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal

5 Faculty of Medicine, University of Coimbra, Coimbra, Portugal

6 Pediatric and Adult Liver Transplantation Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal


Background: Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide and the third cause of cancer-related death. Current clinical/pathological criteria contribute to risk stratification, but are far from the desired on individualized medicine. Recently, HCC classifications have been published based on immunohistochemical and morphological features. Methods: A retrospective review of patients submitted to surgical treatment-partial hepatectomy (PH) or liver transplantation (LT), with pathological diagnosis of HCC, in a 9-year period (2007-2015) was performed. Results: Applying the classification of Srivastava et al. (#1), based on the expression of CD31, p53, AFP and CD44, tumour size and presence of vascular invasion, HCC were categorized as low- and high-risk HCC. With the classification of Tsujikawa et al. (#2), HCC were classified into biliary/stem cell marker positive, Wnt signalling positive and the "all negative" HCC, according to the expression of CK19, SALL4, β-catenin glutamine synthetase, EpCAM and p53. There were sixty-six patients (53 males; 13 females), with median age of 64.5 ± 9.46 years (range 38-86), with solitary HCC, comprehending 37 PH (56.1%) and 29 LT (43.9%). The mean overall survival (OS) was 75.4 ± 6.9 months. Biliary/stem cell type of HCC was a predictive factor of worse OS on the overall population (24.4 versus 78.3 months, p = 0.032) and in PH cohort (11.5 versus 64.01 months, p = 0.016), on uni- and multivariate analyses. Conclusion: These results support the relevance of a risk stratification classification of HCC. Classification #2 seems adequate to our reality demonstrating OS impact, allowing its application in future biopsies, prompting individualized medicine.

Journal of Gastrointestinal Surgeryh

https://pubmed.ncbi.nlm.nih.gov/32410177/