Impact of liver fibrosis severity on oncological prognosis in hepatocellular carcinoma

Abstract

Introduction: Cirrhosis is deemed to be a contributing factor to the postoperative recurrence of hepatocellular carcinoma (HCC), however, the precise impact of liver fibrosis on both cancer-specific prognosis remains unclear. This investigation sought to elucidate the effect of liver fibrosis severity on the cancer-specific prognosis. Methods: A total of 524 consecutive patients were included. Recurrence-free survival (RFS) and disease-specific survival (DSS) were compared according to fibrosis stage. Moreover, postoperative outcomes were subjected to analysis in cohorts of patients with F0 and F1-3, as well as in those with F1-3 and F4, who were carefully matched for background factors. Results: The five-year RFS exhibited a significantly worse outcome in the F4 group compared to other stages of fibrosis [5-year RFS: F0 (46.6%), F1-3 (33.1%) and F4 (23.5%), P=0.03 (F0 vs. F1-3) and P<0.01 (F1-3 vs. F4)]. Additionally, the five-year DSS also presented a significantly worse prognosis in the F4 group (5-year DSS: F0 (82.9%), F1-3 (73.6%) and F4 (57.4%), P=0.04 (F0 vs. F1-3) and P<0.01 (F1-3 vs. F4)]. In multivariate analysis, fibrosis 1, 2, 3, and 4 stage (compared with F0) (HR: 1.70, 1.81, 1.89, and 3.99, 95 % CI: 1.10–1.99, 1.39–2.22, 1.41–2.55, and 2.25–5.01, P=0.022, P=0.008, P<0.001, and P<0.001, respectively) was independent risk factor for RFS. After matched analysis, both RFS and DSS exhibited significantly worse prognoses in the presence of more advanced fibrosis. There was a significantly higher incidence of multiple recurrences in the F4 group than the F1–3 group, and a number of recurrences were observed both in the same hepatic segment as the resected side and in the contralateral lobe in F4 group. Discussion/Conclusion: The hazard and recurrence pattern of HCC signifies that the prognosis could potentially be poor, as the hepatic fibrosis likely owing to a higher hepatocarcinogenic potential, even in the absence of progression to cirrhotic condition. The risk of de novo recurrence may also increase with the progression of this fibrosis.