Brief Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Sep 7, 2013; 19(33): 5534-5541
Published online Sep 7, 2013. doi: 10.3748/wjg.v19.i33.5534
Proposal of new classification for postoperative patients with hepatocellular carcinoma based on tumor growth characteristics
Cui-Hong Zhu, Xiao-Hui Liu, Rui Cao, Xiong-Zhi Wu
Cui-Hong Zhu, Xiao-Hui Liu, Rui Cao, Xiong-Zhi Wu, Zhong-Shan-Men in-Patient Department, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300171, China
Author contributions: Wu XZ analyzed the data and wrote the manuscript; Zhu CH and Cao R collected the patient data; and Liu XH participated in discussions.
Supported by National Science Foundation of China, No. 81173376; and New Century Excellent Talent, No. NCET-11-1068
Correspondence to: Xiong-Zhi Wu, PhD, Zhong-Shan-Men in-Patient Department, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Hexi District, Tianjin 300171, China. ilwxz@163.com
Telephone: +86-22-23921723 Fax: +86-22-28297282
Received: March 7, 2013
Revised: June 3, 2013
Accepted: July 18, 2013
Published online: September 7, 2013
Abstract

AIM: To propose an appropriate staging system for hepatocellular carcinoma (HCC) classification.

METHODS: Here, 288 in-patients with HCC were studied and divided into three groups: those with expansive growth, invasive growth (including satellite nodules, nodule fusions and direct tumor invasion of adjacent organs), or disseminative growth (including vascular involvement, regional lymph node metastasis and distant metastasis). A survival analysis was performed using a Kaplan-Meier analysis, and prognostic factors for overall survival were determined by the Cox proportional hazards regression model.

RESULTS: The overall survival (OS) of patients with invasive tumor growth was shorter than that of patients with expansive tumor growth (27.796 ± 3.730 and 57.398 ± 4.873 mo, respectively, P < 0.001). No significant difference in survival was observed between patients with vascular involvement and patients with regional lymph node metastasis (21.667 ± 4.773 and 14.619 ± 2.456 mo, respectively, P = 0.801). The OS of patients with distant metastasis (6.417 ± 1.395 mo) was shorter than that of the other groups (P < 0.001). No significant difference in survival was observed between patients with expansive tumor growth and vascular and/or regional lymph node involvement and patients with invasive tumor growth and no vascular and/or lymph node involvement (25.762 ± 7.024, 21.200 ± 7.794 and 39.533 ± 5.840 mo, respectively; P = 0.871, 0.307 and 0.563, respectively).

CONCLUSION: These data led to the proposal of a new staging system: the Expansive-Invasive-Disseminative growth staging classification.

Keywords: Hepatocellular carcinoma, Lymph node, Metastasis, Invasive growth, Staging system classification

Core tip: A number of staging systems were designed for all of hepatocellular carcinoma (HCC) patients based on some character of tumor, such as tumor size, vascular invasion, regional lymph node metastasis and extrahepatic spread. But those systems failed to adequately stratify HCC patients with respect to prognosis. In our study, we explore an appropriate staging system for resectable patients with HCC based on tumor’s growth characteristics, the Expansive-Invasive-Disseminative growth staging classification, which is a simple and efficacious prognostic model for postoperative patients with HCC.