Prognostic significance of the serosal invasion in hepatocellular carcinoma

Abstract

The prognostic significance of serosal invasion (SI) was not clarified in patients with hepatocellular carcinoma (HCC). We investigated the impact of SI for the long-term outcome after curative surgical resection in patients with HCC. In total, 783 consecutive patients with HCC who underwent curative surgical resection without any preoperative treatment were histologically evaluated for SI. Patients with SI were classified into two groups: positive for SI (pSI; n = 333) and negative for SI (nSI; n = 450). Clinicopathologic features, disease-free survival (DFS), and overall survival (OS) were compared between patients with pSI and nSI. The pSI group showed more aggressive tumor characteristics, such as higher tumor marker levels (alpha-fetoprotein, p = 0.023; protein induced by vitamin K absence-II, p = 0.016), larger tumor size (p < 0.001), higher prevalence of microvascular invasion (p = 0.002), and poorer differentiation (p = 0.002), than the nSI group. In survival analysis, 5-year DFS was 48.1%, 61.2% in the pSI, nSI, respectively (p < 0.001), while 5-year OS was 74.8%, 86.1%, respectively (p = 0.002). In multivariate analysis, SI was an independent prognostic factor for DFS (p = 0.043) and OS (p = 0.042). The SI was associated with more aggressive clinicopathologic characteristics and a higher risk of poor survival. Therefore, intensive careful follow-up is essential for patients with pSI after curative surgical resection in patients with HCC.