The prognostic significance of histopathological growth patterns in liver metastases undergoing surgery: a systematic review and meta-analysis.

Abstract

Histopathological growth pattern (HGP) is emerging as a promising pathological biomarker in liver metastases, with potential associations to prognosis and response to antiangiogenic therapy. Nonetheless, its prognostic role requires further elucidation for substantial heterogeneity of previous studies. We searched PubMed, Web of Science, Embase and Cochrane Library for studies comparing the overall survival (OS) or disease-free survival (DFS) between different HGPs in liver metastases from various cancer types. Data were pooled using hazard ratios (HRs) along with 95% confidence intervals (CIs) according to fixed or random-effects models. Subgroup analysis was also performed to adjust critical confounders. In total, 36 studies were included in the final analysis. It was demonstrated that desmoplastic HGP (dHGP) was associated with favorable OS compared with non-dHGP (HR, 0.59; 95% CI 0.54-0.64), replacement HGP (rHGP, HR, 0.60; 95% CI 0.49-0.74) and pushing HGP (pHGP, HR, 0.63; 95% CI 0.43-0.92), respectively. Similarly, dHGP also demonstrated improved DFS compared with non-dHGP (HR, 0.58; 95% CI 0.52-0.65), rHGP (HR, 0.61; 95% CI 0.49-0.77) and pHGP (HR, 0.51; 95% CI 0.31-0.83), respectively. In subgroup analysis, dHGPs remains an independent prognostic factor regardless of critical confounders, such as the preoperative systemic therapy, cancer types and HGP categorization criteria. This study confirmed the prognostic role of HGPs in liver metastases receiving surgical resection. Clinically, adding HGPs in prognostic models may provide further optimization.