ASO Author Reflections: Hepatocellular Carcinoma-Related Tumor Necrosis is Associated with Worse Long-Term Outcomes

Excerpt

A range of tumor-specific factors have been associated with the prognosis of patients undergoing resection of hepatocellular carcinoma (HCC).1 In particular, tumor size, number, as well as the presence of microscopic and major vascular invasion, impact the long-term survival of patients with HCC. The importance of these factors has been reflected by their inclusion in the American Joint Committee on Cancer (AJCC) TNM staging system. The performance of the AJCC staging system remains, however, somewhat suboptimal as patients with similar TNM staging can still have disparate outcomes. As such, there is interest in identifying other pathologic factors associated with prognosis. To this end, tumor necrosis has been proposed as a relevant prognostic factor for patients with renal cell carcinoma and colorectal cancer.2,3 Tumor necrosis has been postulated to be associated with a more aggressive tumor phenotype due to impaired oxygen delivery, as well as increased inflammation in the tumor microenvironment.4,5 To date, the impact of HCC tumor necrosis among patients undergoing hepatic resection has not been investigated. We therefore sought to examine the effect of HCC tumor necrosis on the prognosis of patients undergoing curative-intent resection of HCC. …