Proposal of new classification for postoperative patients with hepatocellular carcinoma based on tumor growth characteristics

doi:10.3748/wjg.v19.i33.5534

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastroenterol. Sep 7, 2013; 19(33): 5534-5541
Published online Sep 7, 2013. doi: 10.3748/wjg.v19.i33.5534

Table 1 Patients and tumor characteristics n (%)

Characteristics	n = 288
Age (yr)
≤ 60	208 (72.2)
> 60	80 (27.8)
Gender
Female	49 (17.0)
Male	239 (83.0)
HBV infection	211 (75.36)
TNM stage
I	119 (41.3)
II	22 (7.6)
IIIA	24 (8.3)
IIIB	25 (8.7)
IIIC	66 (22.9)
IVA	21 (7.3)
IVB	11 (3.8)
Tumor size (cm)
≤ 5	105 (36.5)
5 < size ≤ 10	125 (43.4)
> 10	58 (20.1)
Child-Pugh score
A	260 (90.3)
B	28 (9.7)
AFP (ng/mL)
≤ 200	161 (57.7)
> 200	118 (42.3)

HBV: Hepatitis B virus; TNM: Tumor-node-metastasis; AFP: Alpha-fetoprotein.

Table 2 Analysis of factors affecting survival

	Death/all cases	Median survival time (95%CI)	P value
Age (yr)			0.612
≤ 60	165/208	19 (13.470-24.530)
> 60	63/80	23 (15.988-30.012)
Gender			0.605
Male	36/49	20 (6.283-33.717)
Female	193/239	20 (15.131-24.869)
Tumor size (cm)			< 0.001
≤ 5	67/105	34 (17.568-50.432)
5 < size ≤ 10	107/125	17 (8.965-25.035)
> 10	55/58	8 (4.890-11.110)
Tumor status			< 0.001
T1	90/126	33 (24.933-41.067)
T2	14/22	25 (0.000-73.264)
T3a	26/31	15 (5.184-24.816)
T3b	24/27	8 (5.470-10.530)
T4	75/82	12 (7.905-16.095)
Regional lymph node metastasis			< 0.001
No	205/264	22 (16.882-27.118)
Yes	24/24	8 (3.999-12.001)
Distant metastasis			< 0.001
No	217/276	22 (17.691-26.309)
Yes	12/12	4 (2.303-5.697)
Child-Pugh score			< 0.001
A	203/260	23 (18.485-27.515)
B	26/28	7 (2.851-11.149)
AFP (ng/mL)			< 0.001
≤ 200	118/161	28 (21.162-34.838)
> 200	102/118	12 (8.198-15.802)
Expansive growth and invasive growth			< 0.001
Single tumor	103/143	33 (24.408-41.592)
Multiple tumors	18/25	25 (8.680-41.320)
Satellite nodules (including perforation tumor encapsulation)	18/22	13 (10.242-15.758)
Nodules fusion (including diffuse growth which lack tumor encapsulation)	16/18	12 (3.684-20.316)
Direct invasion of adjacent organs other than the gallbladder or with perforation of visceral peritoneum	74/80	12 (7.956-16.044)
Disseminative growth			< 0.001
Without vascular or regional lymph node involvement	155/210	28 (21.928-34.072)
Vascular involvement	42/46	8 (4.979-11.021)
Regional lymph node involvement	21/21	10 (4.019-15.981)
Distant metastasis	12/12	4 (2.303-5.697)
EID stage			< 0.001
I	96/140	36 (27.626-44.374)
II	84/99	16 (11.450-20.550)
III	38/38	8 (4.375-11.625)
IV	11/11	5 (3.436-6.564)
TNM stage			< 0.001
I	84/119	35 (26.448-43.552)
II	14/22	25 (0.000-73.264)
IIIA	19/24	16 (2.557-29.443)
IIIB	22/25	8 (1.880-14.120)
IIIC	58/66	15 (10.033-19.967)
IVA	21/21	10 (4.019-15.981)
IVB	11/11	5 (3.436-6.564)

AFP: Alpha-fetoprotein; EID: Expansive-Invasive-Disseminative growth; TNM: Tumor-node-metastasis.

Table 3 Expansive-Invasive-Disseminative growth staging classification

Phase	Growth characteristics
I	Expansive tumor growth (single tumor and multiple tumors)
II	Expansive tumor growth along with vascular and/or regional lymph node involvement
	Invasive tumor growth (satellite nodules, nodule fusion and tumor direct invasion of adjacent organs)
III	Invasive tumor growth along with vascular/regional lymph node involvement
IV	Distant metastasis of tumor

Table 4 Characteristics of patients as defined by Expansive-Invasive-Disseminative growth stage n (%)

Characteristics	I	II	III	IV
Age (yr)
≤ 60	96 (68.6)	78 (78.8)	26 (68.4)	8 (72.9)
> 60	44 (31.4)	21 (21.2)	12 (31.6)	3 (27.3)
Gender
Female	27 (19.3)	15 (15.2)	5 (13.2)	2 (18.2)
Male	113 (80.7)	84 (84.8)	33 (86.8)	9 (81.8)
HBV infection	105 (75.0)	75 (75.8)	23 (60.5)	8 (72.7)
TNM stage
I	117 (83.6)	2 (2.0)	0	0
II	12 (8.6)	10 (10.1)	0	0
IIIA	9 (6.4)	15 (15.2)	0	0
IIIB	0	20 (20.2)	5 (13.2)	0
IIIC	2 (1.4)	46 (44.5)	18 (47.4)	0
IVA	0	6 (6.1)	15 (39.5)	0
IVB	0	0	0	11 (100)
Tumor size (cm)
≤ 5	71 (50.7)	27 (27.3)	5 (13.2)	2 (18.2)
5 < size ≤ 10	52 (37.1)	50 (50.5)	18 (47.4)	5 (45.5)
> 10	17 (12.1)	22 (22.2)	15 (39.5)	4 (36.4)
Child-Pugh score
A	128 (91.4)	92 (92.9)	30 (78.9)	10 (90.9)
B	12 (8.6)	7 (7.1)	8 (21.1)	1 (9.1)
AFP (ng/mL)
≤ 200	91 (66.4)	46 (47.4)	20 (55.6)	4 (44.4)
> 200	46 (33.6)	51 (52.6)	16 (44.4)	5 (55.6)

HBV: Hepatitis B virus; TNM: Tumor-node-metastasis; AFP: Alpha-fetoprotein.

Citation: Zhu CH, Liu XH, Cao R, Wu XZ. Proposal of new classification for postoperative patients with hepatocellular carcinoma based on tumor growth characteristics. World J Gastroenterol 2013; 19(33): 5534-5541
URL: https://www.wjgnet.com/1007-9327/full/v19/i33/5534.htm
DOI: https://dx.doi.org/10.3748/wjg.v19.i33.5534