Share This Article:

Incidentally Discovered HCC (iHCC) in Explant Liver-Histopathologic Features and Clinical Outcome

Abstract Full-Text HTML XML Download Download as PDF (Size:82KB) PP. 394-398
DOI: 10.4236/jct.2013.42A047    3,835 Downloads   5,899 Views   Citations

ABSTRACT

Incidentally discovered hepatocellular carcinomas (iHCC) are tumors which are discovered on the explanted liver which were not present on imaging prior to transplant. The natural history, histopathologic characteristics and prognosis of iHCC are not clearly defined. Methods: A retrospective analysis was performed to compare the characteristics of iHCC and established HCC within Milan criteria (eHCC) in patients who underwent liver transplantation at our center between 2000 and 2010. Results: During the study period a total of 975 adult patients were transplanted in our center; 124 (12.7%) patients had eHCC and 26 (2.6%) patients had iHCC. A larger number of patients with iHCC (73.1%) had ascites when compared to eHCC (41.3%) (p = 0.035). Patients with iHCC had a higher mean bilirubin (p < 0.001) and mean INR (p = 0.05) than patients with eHCC. Around 70% of patients with iHCC had a Model for End Stage Liver Disease (MELD) score greater than 15 at the time of listing while only 25% of patients with eHCC had a MELD greater than 15 at listing (p < 0.001).The mean alphafetoprotein (AFP) in patients with iHCC was significantly lower (11.6 ± 16.5) than the patients with eHCC (564.9 ± 2180; p = 0.024). In patients with iHCC, 30.8% had a multiple tumors and 23% had bilobar involvement. The average number of tumors was 1.6 and the cumulative tumor size was 2.1 cm (SD 1.4). The cumulative tumor size in iHCC was significantly smaller than in eHCC (mean 3.9 cm) (p = 0.035). American Joint Committee on Cancer (AJCC) T1 tumor stage was found in 58% of patients with iHCC and 48.4% of patients with eHCC (p = 0.829).The median survival was 9.47 years for iHCC (95% CI 7.0 - 11.9) and 8.7 years (95% CI 6.1 - 11.4) for eHCC (p = 0.328). While none of the patients with iHCC had recurrence of HCC, the incidence of recurrence in patients with eHCC was 6.4%. Conclusion: iHCC occurred in patients with more advanced liver disease than eHCC. AFP was usually not elevated in patients with iHCC. The cumulative tumor size of iHCC was smaller than eHCC but around a third of iHCC were multifocal, supporting the theory of multicentric hepatic carcinogenesis. Survival of patients with iHCC was similar to patients with eHCC and recurrence was not noted in patients with iHCC.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

R. Dhanasekaran, D. Pannu, A. Limaye, I. Zendejas, R. Firpi, C. Soldevila-Pico, G. Morelli, V. Clark, A. Suman, D. Nelson and R. Cabrera, "Incidentally Discovered HCC (iHCC) in Explant Liver-Histopathologic Features and Clinical Outcome," Journal of Cancer Therapy, Vol. 4 No. 2A, 2013, pp. 394-398. doi: 10.4236/jct.2013.42A047.

References

[1] R. Dhanasekaran and A. Limaye, “Hepatocellular Carcinoma: Current Trends in Worldwide Epidemiology, Risk Factors, Diagnosis, and Therapeutics,” Hepatic Medicine: Evidence and Research, Vol. 4, 2012, pp. 19-37.
[2] Surveillance Research Program, National Cancer Institute, “Fast Stats: An Interactive Tool for Access to SEER Cancer Statistics,” 2011. http://seer.cancer.gov/faststats
[3] V. Mazzaferro, et al., “Liver Transplantation for the Treatment of Small Hepatocellular Carcinomas in Patients with Cirrhosis,” The New England Journal of Medicine, Vol. 334, No. 11, 1996, pp. 693-699. doi:10.1056/NEJM199603143341104
[4] J. Bruix and M. Sherman, “Management of Hepatocellular Carcinoma: An Update,” Hepatology, Vol. 53, No. 3, 2011, pp. 1020-1022. doi:10.1002/hep.24199
[5] J. A. Davila, et al., “Use of Surveillance for Hepatocellular Carcinoma among Patients with Cirrhosis in the United States,” Hepatology, Vol. 52, No. 1, 2010, pp. 132-141. doi:10.1002/hep.23615
[6] E. K. Outwater, “Imaging of the Liver for Hepatocellular Cancer,” Cancer Control, Vol. 17, No. 2, 2010, pp. 72-82.
[7] A. Colli, et al., “Accuracy of Ultrasonography, Spiral CT, Magnetic Resonance, and Alpha-Fetoprotein in Diagnosing Hepatocellular Carcinoma: A Systematic Review,” American Journal of Gastroenterology, Vol. 101, No. 3, 2006, pp. 513-523. doi:10.1111/j.1572-0241.2006.00467.x
[8] M. J. Kim, “Current Limitations and Potential Breakthroughs for the Early Diagnosis of Hepatocellular Carcinoma,” Gut Liver, Vol. 5, No. 1, 2011, pp. 15-21. doi:10.5009/gnl.2011.5.1.15
[9] G. C. Sotiropoulos, et al., “Liver Transplantation and Incidentally Found Hepatocellular Carcinoma in Liver Explants: Need for a New Definition?” Transplantation, Vol. 81, No. 4, 2006, pp. 531-535. doi:10.1097/01.tp.0000198739.42548.3e
[10] Y. Kishi, et al., “Impact of Incidentally Found Hepatocellular Carcinoma on the Outcome of Living Donor Liver Transplantation,” Transplant International, Vol. 19, No. 9, 2006, pp. 720-725. doi:10.1111/j.1432-2277.2006.00338.x
[11] R. Raphe, et al., “Histopathologic Characteristics of Incidental Hepatocellular Carcinoma after Liver Transplantation,” Transplantation Proceedings, Vol. 42, No. 2, 2010, pp. 505-506. doi:10.1016/j.transproceed.2010.01.034
[12] S. H. Choi, et al., “Clinicopathological Features of Incidental Hepatocellular Carcinoma in Liver Transplantation,” Transplantation Proceedings, Vol. 36, No. 8, 2004, pp. 2293-2294. doi:10.1016/j.transproceed.2004.08.076
[13] A. Caroli-Bottino, et al., “Hepatocellular Carcinoma: Incidental Finding in Cirrhotic Explanted Livers,” Transplantation Proceedings, Vol. 37, No. 6, 2005, pp. 2791-2792. doi:10.1016/j.transproceed.2005.07.014
[14] F. L. Greene, D. L. Page, I. D. Fleming, A. Fritz, C. M. Balch, D. G. Haller, et al., Eds., “AJCC Cancer Staging Manual,” 6th Edition, Springer, Chicago, 2002.
[15] F. Mion, et al., “Adult Cirrhotic Liver Explants: Precancerous Lesions and Undetected Small Hepatocellular Carcinomas,” Gastroenterology, Vol. 111, No. 6, 1996, pp. 1587-1592. doi:10.1016/S0016-5085(96)70021-5
[16] J. A. Fernandez, et al., “Can We Expand the Indications for Liver Transplantation among Hepatocellular Carcinoma Patients with Increased Tumor Size?” Transplant Proceedings, Vol. 35, No. 5, 2003, pp. 1818-1820. doi:10.1016/S0041-1345(03)00723-1
[17] R. B. Freeman Jr., et al., “Model for End-Stage Liver Disease (MELD) Exception Guidelines: Results and Recommendations from the MELD Exception Study Group and Conference (MESSAGE) for the Approval of Patients Who Need Liver Transplantation with Diseases Not Considered by the Standard MELD Formula,” Liver Transplantation, Vol. 12, No. S3, 2006, pp. S128-S136. doi:10.1002/lt.20979
[18] E. A. Pomfret, et al., “Report of a National Conference on Liver Allocation in Patients with Hepatocellular Carcinoma in the United States,” Liver Transplantation, Vol. 16, No. 3, 2010, pp. 262-278. doi:10.1002/lt.21999
[19] A. J. Sanyal, S. K. Yoon and R. Lencioni, “The Etiology of Hepatocellular Carcinoma and Consequences for Treatment,” The Oncologist, Vol. 15, No. S4, 2010, pp. 14-22. doi:10.1634/theoncologist.2010-S4-14
[20] H. B. El-Serag, “Hepatocellular Carcinoma,” New England Journal of Medicine, Vol. 365, No. 12, 2011, pp. 1118-1127. doi:10.1056/NEJMra1001683
[21] A. Luca, et al., “Multidetector-Row Computed Tomography (MDCT) for the Diagnosis of Hepatocellular Carcinoma in Cirrhotic Candidates for Liver Transplantation: Prevalence of Radiological Vascular Patterns and Histological Correlation with Liver Explants,” European Radiology, Vol. 20, No. 4, 2010, pp. 898-907. doi:10.1007/s00330-009-1622-0
[22] G. A. Krinsky, et al., “Transplantation for Hepatocellular Carcinoma and Cirrhosis: Sensitivity of Magnetic Resonance Imaging,” Liver Transplantation, Vol. 8, No. 12, 2002, pp. 1156-1164. doi:10.1053/jlts.2002.35670
[23] N. C. Yu, et al., “CT and MRI Improve Detection of Hepatocellular Carcinoma, Compared with Ultrasound Alone, in Patients with Cirrhosis,” Clinical Gastroenterology and Hepatology, Vol. 9, No. 2, 2011, pp. 161-167. doi:10.1016/j.cgh.2010.09.017
[24] K. Takahashi, et al., “Frequent Loss of Heterozygosity on Chromosome 22 in Hepatocellular Carcinoma,” Hepatology, Vol. 17, No. 5, 1993, pp. 794-799. doi:10.1002/hep.1840170508
[25] I. O. Ng, et al., “Determination of the Molecular Relationship between Multiple Tumour Nodules in Hepatocellular Carcinoma Differentiates Multicentric Origin from Intrahepatic Metastasis,” Journal of Pathology, Vol. 199, No. 3, 2003, pp. 345-353. doi:10.1002/path.1287
[26] M. Esumi, et al., “Clonal Origin of Human Hepatoma Determined by Integration of Hepatitis B Virus DNA,” Cancer Research, Vol. 46, No. 11, 1986, pp. 5767-5771.
[27] O. Morimoto, et al., “Diagnosis of Intrahepatic Metastasis and Multicentric Carcinogenesis by Microsatellite Loss of Heterozygosity in Patients with Multiple and Recurrent Hepatocellular Carcinomas,” Journal of Hepatology, Vol. 39, No. 2, 2003, pp. 215-221. doi:10.1016/S0168-8278(03)00233-2

  
comments powered by Disqus

Copyright © 2019 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.