Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Feb 27, 2017; 9(2): 61-67
Published online Feb 27, 2017. doi: 10.4240/wjgs.v9.i2.61
Clinicopathological features and surgical outcome of patients with fibrolamellar hepatocellular carcinoma (experience with 22 patients over a 15-year period)
Mohamed Abdel Wahab, Ehab El Hanafy, Ayman El Nakeeb, Mahmoud Abdelwahab Ali
Mohamed Abdel Wahab, Ehab El Hanafy, Ayman El Nakeeb, Mahmoud Abdelwahab Ali, Gastroenterology Surgical Center, Mansoura University, Mansoura 35516, Egypt
Author contributions: Wahab MA and El Hanafy E contributed to study concept; Wahab MA, El Hanafy E and El Nakeeb A contributed to data collection; El Hanafy E and El Nakeeb A contributed to data analysis; Wahab MA and Ali MA contributed to writing the draft; all authors have approved the manuscript in its final form and approving the manuscript in its final form.
Institutional review board statement: This study was approved by institutional review board Faculty of medicine Mansoura University, Code number: R/16.01.03.
Informed consent statement: Informed consent was obtained from all patients to undergo surgery after a careful explanation of the nature of the disease and possible treatment with its complications.
Conflict-of-interest statement: No conflict of interest; No financial support.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ehab El Hanafy, MD, Assistant Professor, Gastroenterology Surgical Center, Mansoura University, Elgomhouria St., Mansoura 35516, Egypt. dr_ehab_elhanafy@yahoo.com
Telephone: +20-100-5271523 Fax: +20-502-202542
Received: September 15, 2016
Peer-review started: September 19, 2016
First decision: October 21, 2016
Revised: November 28, 2016
Accepted: December 13, 2016
Article in press: December 14, 2016
Published online: February 27, 2017
Abstract
AIM

To evaluate the clinicopathological features and the surgical outcomes of patients with fibrolamellar hepatocellular carcinoma (FL-HCC) over a 15-year period.

METHODS

This is a retrospective study including 22 patients with a pathologic diagnosis of FL-HCC who underwent hepatectomy over a 15-year period. Tumor characteristics, survival and recurrence were evaluated.

RESULTS

There were 11 male and 11 female with a median age of 29 years (range from 21 to 58 years). Two (9%) patients had hepatitis C viral infection and only 2 (9%) patients had alpha-fetoprotein level > 200 ng/mL. The median size of the tumors was 12 cm (range from 5-20 cm). Vascular invasion was detected in 5 (23%) patients. Four (18%) patients had lymph node metastases. The median follow up period was 42 mo and the 5-year survival was 65%. Five (23%) patients had a recurrent disease, 4 of them had a second surgery with 36 mo median time interval. Vascular invasion is the only significant negative prognostic factor

CONCLUSION

FL-HCC has a favorable prognosis than common HCC and should be suspected in young patients with non cirrhotic liver. Aggressive surgical resection should be done for all patients. Repeated hepatectomy should be considered for these patients as it has a relatively indolent course.

Keywords: Fibrolamellar hepatocellular carcinoma, Common hepatocellular carcinoma, Recurrence after resection fibrolamellar hepatocellular carcinoma, Pathology of fibrolamellar hepatocellular carcinoma, Survivalefter resection fibrolamellar hepatocellular carcinoma

Core tip: Fibrolamellar hepatocellular carcinoma (FL-HCC) has conventionally been considered to be a histologic variant of HCC, with distinct clinicopathologic features. Many series have mentioned that FL-HCC is less aggressive than conventional HCC. However, other studies have failed to confirm the observation of a better outcome in FL-HCC. Our study shows that FL-HCC has a favorable prognosis than common HCC and should be suspected in young patients with non cirrhotic liver. Aggressive surgical resection should be done for all patients. Repeated hepatectomy or excision of recurrent disease should be considered for these patients as it has a relatively indolent course.