Recently published data revealed a significant association between low lymphocyte infiltration in hepatocellular carcinoma tumors and higher recurrence rates and poor overall survival compared with high lymphocyte infiltration.
“Most cases of HCC are secondary to chronic hepatitis and cirrhosis resulting from hepatitis B virus or hepatitis C virus infection or from non viral-related causes such as alcohol or non-alcoholic [fatty] liver disease (NAFLD),” the researchers wrote. “We aimed to show the association between prognosis or HCC recurrence in the patients who underwent curative surgery for HBV-positive or [non-hepatitis B or C] patients.”
The retrospective study comprised 145 patients with HCC who underwent hepatic resection between January 2001 and May 2009. The researchers assessed lymphocyte infiltration in tumors with a score of zero to two according to the mean number from five high-powered fields, gathered through hematoxylin and eosin staining.
Seventy-four patients had high lymphocyte infiltration defined by a score of one or two and 71 patients had low lymphocyte infiltration defined by a score of zero.
Patients with HBV-related HCC has higher lymphocyte infiltration, while patients with NAFLD-related HCC had lower infiltration (P = .009). Other factors associated with high lymphocyte infiltration included high albumin (P = .012), smaller tumor size (P = .008) and low alpha-fetoprotein-L3 (P = .022).
Patients with high lymphocyte infiltration had recurrence rates of 27.6% at 2 years and 55.3% at 5 years and OS rates of 92.9% at 2 years and 83.7% at 5 years. In comparison, the recurrence rate at 2 years was 64% and at 86.4% at 5 years for patients with low lymphocyte infiltration, while OS rates were 82% at 2 years and 44.1% at 5 years. Data showed an association among low lymphocyte infiltration and high recurrence (P < .001) and poor OS (P < .001).
On multivariate analysis, the factors associated with high recurrence rate were albumin value less than 3.5 g/dL (HR = 2.33; 95% CI, 1.24-4.41), American Joint Committee on Cancer (AJCC) T-stage 2 or 3 (HR = 2.31; 95% CI, 1.42-3.74), AFP value over 200 U/mL (HR = 2.06; 95% CI, 1.25-3.4) and high lymphocyte infiltration (HR = 2.5; 95% CI, 1.56-4.02).
The multivariate analysis for OS factors showed significant association with albumin value less than 3.5 g/dL (HR = 3.69; 95% CI, 1.62-7.42), AJCC T-stage 2 or 3 (HR = 2.1; 95% CI, 1-4.4), AFP value over 200 U/mL (HR = 3.98; 95% CI, 1.94-8.12) and high lymphocyte infiltration (HR = 3.47; 95% CI, 1.62-7.42).
“It is necessary to modify the treatment strategy and follow-up of HCC patients based on tumor stage, liver function, and the type of viral hepatitis,” the researchers concluded. “If a precise prediction of early recurrence or poor prognosis can be achieved preoperatively, the surgeon could choose the alternative treatments (eg, transplant or local ablation therapy) or give neoadjuvant therapies as a clinical trial. There has, however, been little evidence of the benefit of neoadjuvant regional or systemic therapies.” – by Talitha Bennett
Disclosure: Healio.com/Hepatology was unable to confirm relevant financial disclosures at the time of publication.