[Clinicopathological characteristics and prognostic significance of steatotic hepatocellular carcinoma with HBV-related cirrhosis: a propensity score-matched study].
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Objective: To investigate the clinicopathological characteristics of steatotic hepatocellular carcinoma with HBV-related cirrhosis (SBC-HCC) and its prognostic impact after curative resection. Methods: This is a retrospective cohort study. Data were retrospectively collected from 877 patients who underwent hepatectomy and were postoperatively confirmed as hepatocellular carcinoma (HCC) by pathological examination at Department of Hepatobiliary and Pancreatic Surgery, Qingdao University Affiliated Hospital between January 2014 and December 2020. After screening based on inclusion and exclusion criteria, a total of 689 patients were included in the subsequent analysis. There were 563 male cases (82.1%) and 126 female cases (17.9%); the age (M(IQR)) was 58 (13) years (range: 17 to 85 years). SBC-HCC was defined by digital pathology quantitative assessment as an intratumoral lipid vacuole proportion >5% in tumor cells. Patients were grouped by SBC-HCC status, and 1∶3 propensity score matching (PSM; caliper 0.02) was performed to balance baseline characteristics. Clinicopathological variables, overall survival (OS), and disease-free survival (DFS) were compared between groups. The clinical and pathological characteristics of patients in the two groups were compared using the χ² test, Fisher's exact probability method, independent samples t-test, or Mann-Whitney U test,respectively.Cox proportional hazards models were used to identify independent prognostic factors, and subgroup analyses were conducted. Results: Among the 689 patients, 107 patients (15.5%) were classified as SBC-HCC. After PSM, 79 patients with SBC-HCC and 237 patients without SBC-HCC were included. Major demographic and tumor-related variables were well balanced between groups; however, SBC-HCC patients had higher levels of total bile acids, total cholesterol, low-density lipoprotein cholesterol, and creatinine than non-SBC-HCC patients (all P<0.05). The follow-up time was 51(34) months(range:1 to 139 months). The median OS time was 90.8 months in the SBC-HCC group and was not reached in the non-SBC-HCC group (P=0.012). The SBC-HCC group had significantly lower 5-year OS rate (69.2% vs. 72.9%) and 5-year DFS rate (34.4% vs. 44.5%) than the non-SBC-HCC group (both P<0.05). In multivariable Cox analysis for overall survival, SBC-HCC (HR=1.939, 95%CI: 1.291 to 2.913,P<0.01), increased tumor number (HR=1.694, 95%CI: 1.321 to 2.172, P<0.01), microvascular invasion (HR=1.880, 95%CI: 1.133 to 3.122,P=0.015), and tumor size ≥5 cm (HR=3.479, 95%CI: 2.256 to 5.364, P<0.01) emerged as independent risk factors for poor OS. For DFS, elevated LDL-C (HR=1.242, 95%CI: 1.022 to 1.510, P=0.029), microvascular invasion (HR=1.866, 95%CI: 1.251 to 2.785, P<0.01), and macrovascular invasion (HR=2.557, 95%CI: 1.473 to 4.439,P<0.01) were independently associated with an increased risk of recurrence.Subgroup analyses showed that SBC-HCC was associated with poorer survival outcomes in some clinicopathological subgroups (all P<0.05). Conclusions: SBC-HCC accounts for a non-negligible proportion of HBV-related HCC and is characterized by lipid metabolism-related clinical features. The presence of SBC-HCC is independently associated with worse survival outcomes after curative resection and may serve as a useful adjunct to routine pathological assessment for postoperative risk stratification and follow-up management.