Diffuse infiltrative hepatocellular carcinoma: Assessment of presentation, treatment, and outcomes

Peter J. Kneuertz, Aram Demirjian, Amin Firoozmand, Celia Corona-Villalobos, Nikhil Bhagat, Joseph Herman, Andrew Cameron, Ahmet Gurakar, David Cosgrove, Michael A. Choti, Jean Francois H. Geschwind, Ihab R. Kamel, Timothy M. Pawlik

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Abstract

Background: Data on infiltrating hepatocellular carcinoma (HCC) are limited. We sought to define treatment and outcome of patients treated with infiltrating HCC compared with patients who had advanced multifocal HCC. Methods: Between January 2000 and July 2011, a total of 147 patients with advanced HCC were identified from the Johns Hopkins Hospital database (infiltrative, n = 75; multifocal, n = 72). Clinicopathologic data were compared by HCC subtype. Results: Patients with infiltrating HCC had higher alfafetoprotein levels (median infiltrative, 326.5 ng/mL vs. multifocal, 27.0 ng/mL) and larger tumors (median size, infiltrating, 9.2 cm vs. multifocal, 5.5 cm) (P <0.05). Imaging failed to reveal a discrete lesion in 42.7 % of patients with infiltrating HCC. Most infiltrating HCC lesions presented as hypointense on T1-weighted images (55.7 %) and hyperintense on T2-weighted images (80.3 %). Among patients with infiltrating HCC, most (64.0 %) were treated with intra-arterial therapy (IAT), and periprocedural morality was 2.7 %. Patients treated with IAT had longer survival versus patients receiving best support care (median survival, IAT, 12 months vs. best supportive care, 3 months; P = 0.001). Survival after IAT was similar among patients treated with infiltrating HCC versus multifocal HCC (hazard ratio 1.29, 95 % confidence interval 0.82-2.03; P = 0.27). Among infiltrating HCC patients, pretreatment bilirubin ≥2 mg/dL and alfa-fetoprotein > 400 ng/mL were associated with worse survival after IAT (P < 0.05). Patients with progressive disease after IAT had higher risk of death versus patients who had stable/responsive disease (hazard ratio 3.53, 95 % confidence interval 1.49-8.37; P = 0.004). Conclusions: Patients with infiltrative HCC often present without a discrete lesion on imaging. IAT for infiltrative HCC was safe and was associated with survival comparable to IAT outcomes for patients with multifocal HCC. Infiltrative HCC morphology is not a contraindication to IAT therapy in select patients.

Original languageEnglish (US)
Pages (from-to)2897-2907
Number of pages11
JournalAnnals of Surgical Oncology
Volume19
Issue number9
DOIs
StatePublished - Sep 1 2012

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ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Kneuertz, P. J., Demirjian, A., Firoozmand, A., Corona-Villalobos, C., Bhagat, N., Herman, J., Cameron, A., Gurakar, A., Cosgrove, D., Choti, M. A., Geschwind, J. F. H., Kamel, I. R., & Pawlik, T. M. (2012). Diffuse infiltrative hepatocellular carcinoma: Assessment of presentation, treatment, and outcomes. Annals of Surgical Oncology, 19(9), 2897-2907. https://doi.org/10.1245/s10434-012-2336-0