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The Impact of Histologic Liver Inflammation on Oncology and the Prognosis of Patients Undergoing Hepatectomy for Hepatocellular Carcinoma

  • Hepatobiliary Tumors
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Abstract

Background

Liver inflammation is a reaction to disease-causing stress in the liver that induces fibrosis and cirrhosis. However, its prognostic impact after hepatectomy remains unclear. This study aimed to evaluate the prognostic and oncologic impacts of liver inflammation on patients after curative hepatectomy for hepatocellular carcinoma (HCC).

Methods

The study enrolled 500 consecutive patients with primary HCC who underwent curative and primary hepatectomy. Patient characteristics and prognoses were evaluated according to histologic liver inflammation assessed by the New Inuyama Classification.

Results

Severe liver inflammation (A3) was observed in 97 patients (19.4%) and nonsevere liver inflammation (A0-2) in 403 patients (80.6%). The patients with A3 had a significantly poorer prognosis than those with A0-2 in terms of relapse-free survival (p < 0.0001, log-rank) and overall survival (p = 0.0013, log-rank). The study showed that A3 is an independent poor prognostic factor (hazard ratio, 1.36; 95% confidence interval [Cl], 1.02–1.81; p = 0.039), and that Child-Pugh grade B and multiple tumors are associated with relapse-free survival. Furthermore, The significant predictors of early recurrence (within 2 years after hepatectomy) were A3 (odds ratio, 2.10; 95% CI, 1.25–3.55; p = 0.005), a des-γ-carboxyprothrombin level higher than 40 mAU/mL, and multiple tumors.

Conclusions

Severe liver inflammation was associated with poor short- and long-term prognoses independently of cirrhosis. Controlling liver inflammation in the perioperative period may be essential to improving the prognosis of patients with HCC after hepatectomy.

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Acknowledgments

We thank the American Journal Experts team (https://www.aje.com) for editing a draft this report.

Funding

This study was supported by the Japan Society for the Promotion of Science (JSPS); 201960331 and 20K16418 (TM).

There are no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan

    Tatsunori Miyata MD, PhD, Hiromitsu Hayashi MD, PhD, Yo-ichi Yamashita MD, PhD, Kazuki Matsumura MD, Takaaki Higashi MD, PhD, Katsunori Imai MD, PhD, Hidetoshi Nitta MD, PhD, Akira Chikamoto MD, PhD, Toru Beppu MD, PhD & Hideo Baba MD, PhD, FACS

  2. Department of Surgery, Yamaga City Medical Center, Kumamoto, Japan

    Toru Beppu MD, PhD

Authors
  1. Tatsunori Miyata MD, PhD
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  2. Hiromitsu Hayashi MD, PhD
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  3. Yo-ichi Yamashita MD, PhD
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  4. Kazuki Matsumura MD
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  5. Takaaki Higashi MD, PhD
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  6. Katsunori Imai MD, PhD
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  7. Hidetoshi Nitta MD, PhD
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  8. Akira Chikamoto MD, PhD
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  9. Toru Beppu MD, PhD
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  10. Hideo Baba MD, PhD, FACS
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Corresponding author

Correspondence to Hideo Baba MD, PhD, FACS.

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Supplementary Figure 1

In the patients with A3 (n = 96), we also evaluated the prognostic impact of etiology (HBV or HCV or NBNC), and there was no significant difference in RFS and OS. *One patient was infected with both HBV and HCV, and was excluded from this study due to low statisticalnumbers (TIFF 9202 kb)

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Miyata, T., Hayashi, H., Yamashita, Yi. et al. The Impact of Histologic Liver Inflammation on Oncology and the Prognosis of Patients Undergoing Hepatectomy for Hepatocellular Carcinoma. Ann Surg Oncol 29, 893–902 (2022). https://doi.org/10.1245/s10434-021-10706-7

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  • DOI: https://doi.org/10.1245/s10434-021-10706-7

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