Preprint Article Version 1 This version is not peer-reviewed

A Proposal for a Simple Subclassification of Advanced Hepatocellular Carcinoma in Systemic Treatment

Norihiro Imai
* ORCID logo ,
Takafumi Yamamoto
,
Kazuyuki Mizuno
,
Shinya Yokoyama
ORCID logo ,
Kenta Yamamoto
ORCID logo ,
Takanori Ito
,
Yoji Ishizu
,
Teiji Kuzuya
ORCID logo ,
Takashi Honda
,
Tetsuya Ishikawa
ORCID logo ,
Hiroki Kawashima
Version 1 : Received: 9 October 2024 / Approved: 10 October 2024 / Online: 10 October 2024 (09:08:49 CEST)

How to cite: Imai, N.; Yamamoto, T.; Mizuno, K.; Yokoyama, S.; Yamamoto, K.; Ito, T.; Ishizu, Y.; Kuzuya, T.; Honda, T.; Ishikawa, T.; Kawashima, H. A Proposal for a Simple Subclassification of Advanced Hepatocellular Carcinoma in Systemic Treatment. Preprints 2024, 2024100745. https://doi.org/10.20944/preprints202410.0745.v1 Imai, N.; Yamamoto, T.; Mizuno, K.; Yokoyama, S.; Yamamoto, K.; Ito, T.; Ishizu, Y.; Kuzuya, T.; Honda, T.; Ishikawa, T.; Kawashima, H. A Proposal for a Simple Subclassification of Advanced Hepatocellular Carcinoma in Systemic Treatment. Preprints 2024, 2024100745. https://doi.org/10.20944/preprints202410.0745.v1

Abstract

Objectives: This study focused on the presence or absence of vascular invasion and extrahepatic metastasis in hepatocellular carcinoma (HCC) and examined their impact on systemic treatment outcomes. Methods: We retrospectively analyzed 362 patients with unresectable HCC who received first-line systemic therapy. The prognostic evaluation was based on the presence of vascular invasion and extrahepatic metastasis at the time of treatment initiation. Results: Patients with vascular invasion or extrahepatic metastasis (advanced group) had significantly worse outcomes than those without these features (intermediate group), with median survival times of 434 and 658 days, respectively. Further subdivision of the advanced group into three categories—patients with only extrahepatic metastasis (m group, n = 77), patients with only vascular invasion (v group, n = 78), and patients with both vascular invasion and extrahepatic metastasis (vm group, n = 52)—revealed that the m group had significantly better outcomes than those in the other two groups, with median survival times of 649, 323, and 187 days, respectively. A comparison of the clinical backgrounds among the three groups demonstrated that the m group had significantly better liver function at the time of treatment initiation than that in the other two groups. Multivariate analysis, including performance status, Child–Pugh score, and the use of immune checkpoint inhibitors as first-line therapy, identified the m group as an independent and significant prognostic factor (hazard ratio, 0.50). Conclusions: Unresectable HCC with extrahepatic metastasis and no vascular invasion represents a novel staging category for systemic treatment.

Keywords

advanced hepatocellular carcinoma; immune checkpoint inhibitor; vascular invasion; extrahepatic metastasis

Subject

Medicine and Pharmacology, Gastroenterology and Hepatology

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Download PDF

Comments (0)

We encourage comments and feedback from a broad range of readers. See criteria for comments and our Diversity statement.

Leave a public comment
Send a private comment to the author(s)
* All users must log in before leaving a comment
Views 0
Downloads 0
Comments 0
Get PDF Cite Share 0
Bookmark BibSonomy Mendeley Reddit Delicious
×
Alerts
Notify me about updates to this article or when a peer-reviewed version is published.
We use cookies on our website to ensure you get the best experience.
Read more about our cookies here.