Clinicopathological features and surgical outcome of patients with fibrolamellar hepatocellular carcinoma (experience with 22 patients over a 15-year period)

Table 1 Patient demographics

	FL-HCC (n = 22)
Median age, years (range)	29 yr (21 to 58)
Male/female	11/11 (50%:50%)
Hepatitis or cirrhosis	2 (9%)
Elevated AFP (> 200 ng/mL)	2 (9%)

FL-HCC: Fibrolamellar hepatocellular carcinoma; AFP: Alpha-fetaprotein.

Table 2 Tumor characteristics’ and treatment features n (%)

	FL-HCC (n = 22 )
Number
Single	19 (86)
Multiple	3 (14)
Size (cm)	Median 12 cm (range, 5-20 )
Location	9 right, 10 left, 3 bilateral
Hepatic resection
Hepatectomy	16 (73)
Extended hepatectomy	4 (18)
Localized resection	2 (9)
Stage
I	10 (45)
II	5 (23)
III	7 (32)
IV	0
Nodal metastases	4 (18)
Vascular invasion	5 (23)
Positive safety margin	2 (9)
Repeated hepatectomy	4 (18)

FL-HCC: Fibrolamellar hepatocellular carcinoma.

Table 3 Clinicopathologic features and survival in fibrolamellar carcinoma (figures in parenthesis reflect percentages)

Factor	n (%)	Overall survival (mo)	P value
Age (yr)
< 40	16 (73)	86
≥ 40	6 (27)	72	0.4
Gender
Female	11 (50)	84
Male	11 (50)	79	0.6
Tumor size (cm)
< 10	8 (36)	82
≥ 10	14 (64)	76	0.3
Number
1	19 (86)	89
> 1	3 (14)	77	0.2
Hepatic resection
Hepatectomy	16 (73)	86
Extended hepatectomy	4 (18)	77
Localized resection	2 (9)	79	0.62
Nodal metastases
Negative	18 (82)	88
Positive	4 (18)	78	0.09
Vascular invasion
Absent	17 (77)	92
Present	5 (23)	58	0.03
Safety margin
Negative	20 (91)	87
Positive	2 (9)	72	0.08

Table 4 Published series on fibrolamellar hepatocellular carcinoma

Ref.	n	Age	Male:female	Cirrhosis/ hepatitis	AFP elevated	Median size (cm)	> 1 tumor	Positive node	Vascular invasion	Initial operation	Repeat operation	Median f/u	5 yr survival	Prognostic factor
Hemming et al[18], 1997	10	31	50:50	NR	10%	8	20%	20%	NR	Phx 100%	50%	101	70%	NR
El-Gazzaz et al[19], 2000	20	27	65:35	0% hep B	0%	14	20%	30%	55%	Phx 55% OLT 45%	NR	25	50%	NONE
Kakar et al[20], 2005	20	27	53:27	0%	3/13 (23%)	< 10 31% ≥ 10 69%	10%	35%	NR	Phx 100%	NR	NR	62%	Metastasis at presentation
Stipa et al[21], 2006	28	28	43:57	0%	7%	9	11%	50%	36%	Phx 100%	61%	34	76%	Positive LN
Present study	22	29	50:50	9%/hepc	9%	12	13%	18%	23%	Phx 100%	18%	42	65%	Vascular invasiom

Hep: Hepatitis; AFP: Alpha-fetoprotein elevated (> 200 ng/mL); Phx: Partial hepatectomy; NR: Not reported; f/u: Follow up.