Prognostication algorithm for non-cirrhotic non-B non-C hepatocellular carcinoma-a multicenter study under the aegis of the French Association of Hepato-Biliary Surgery and liver Transplantation

Background: Liver resection and local ablation are the only curative treatment for non-cirrhotic hepatocellular carcinoma (HCC). Few data exist concerning the prognosis of patients resected for non-cirrhotic HCC. The objectives of this study were to determine the prognostic factors of recurrence-free survival (RFS) and overall survival (OS) and to develop a prognostication algorithm for non-cirrhotic HCC. Methods: French multicenter retrospective study including HCC patients with non-cirrhotic liver without underlying viral hepatitis: F0, F1 or F2 fibrosis. Results: A total of 467 patients were included in 11 centers from 2010 to 2018. Non-cirrhotic liver had a fibrosis score of F0 (n=237, 50.7%), F1 (n=127, 27.2%) or F2 (n=103, 22.1%). OS and RFS at 5 years were 59.2% and 34.5%, respectively. In multivariate analysis, microvascular invasion and HCC differentiation were prognostic factors of OS and RFS and the number and size were prognostic factors of RFS (P < 0.005). Stratification based on RFS provided an algorithm based on size (P=0.013) and number (P < 0.001): 2 HCC with the largest nodule <= 10 cm (n=271, Group 1); 2 HCC with a nodule > 10 cm (n=176, Group 2); > 2 HCC regardless of size (n=20, Group 3). The 5-year RFS rates were 52.7% (Group 1), 30.1% (Group 2) and 5% (Group 3). Conclusions: We developed a prognostication algorithm based on the number (& LE; or > 2) and size (< or > 10 cm), which could be used as a treatment decision support concerning the need for perioperative therapy. In case of bifocal HCC, surgery should not be a contraindication.

Automated summary

This study investigated the prognostic factors of non-cirrhotic hepatocellular carcinoma (HCC) and developed a prognostication algorithm. The results showed that microvascular invasion, HCC differentiation, tumor number, and size were important factors affecting overall survival and recurrence-free survival of patients. Stratification based on recurrence-free survival provided an algorithm based on tumor size and number, which could be used as a reference for treatment decision-making during the perioperative period.