Department of Medicine, University of California, San Francisco, San Francisco, CA. Electronic address: Neil.Mehta@ucsf.edu.
BACKGROUND & AIMS:
Infiltrative hepatocellular carcinoma (iHCC) is characterized by its indistinct borders and lack of a typical pattern of contrast enhancement. There are few published data on iHCC. We assessed outcomes, effects of treatment, and prognostic factors in a large cohort of patients with iHCC.
We analyzed data from 155 patients (median age 60 years; 79% male; median level of α-fetoprotein [AFP] 347 ng/mL; median model for end-stage liver disease score [MELD] 13) with iHCC, based on contrast-enhanced computed tomography or magnetic resonance imaging, from 2002 to 2010 at the University of California, San Francisco Medical Center. All imaging study results were independently reviewed by 2 investigators.
Most of the patients had tumors of Barcelona Clinic Liver Cancer stage C (70%) or D (22%). The median maximum tumor diameter was 11.3 cm; 41% of lesions were hypovascular, 82% had macrovascular invasion, and 52% had extra-hepatic metastases. Median survival was 4.0 months, and rates of survival at 6 and 12 months were 30% and 10%, respectively. On multivariate analysis, predictors of 6-month mortality were Child-Pugh class B or C cirrhosis; lack of tumor-directed therapy with chemoembolization (TACE), radiofrequency ablation, or sorafenib; AFP level >1000 ng/mL; female sex; MELD score; and maximum tumor diameter. The percentages of patients surviving 6 and 12 months were 17% and 2% for those that received no therapy (n=109), 73% and 36% for those that received sorafenib (n=11), and 45% and 17% for those that that received TACE (n=18) (all P values <.01).
iHCC is a radiographically distinct and advanced form of HCC with a poor prognosis. Therapy with TACE or sorafenib appears to prolong survival and requires further investigation.