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Prognosis of Fibrolamellar Carcinoma Compared to Non-Cirrhotic Conventional Hepatocellular Carcinoma
Suguru Yamashita*1, Yun Shin Chun1, Guillaume Passot1, Claudius Conrad1, Thomas Aloia1, MA Shama2, Kanwal Raghav2, Manal Hassan2, Ahmed Kaseb2, Jean-Nicolas Vauthey1
1Surgical Oncology, MD Anderson, Houston, TX; 2Gastrointestinal Medical Oncology, MD Anderson Cancer Center, Houston, TX
Background: Fibrolamellar carcinoma (FLC) and conventional hepatocellular carcinoma (HCC) share the same American Joint Committee on Cancer (AJCC) staging. The worse survival with HCC is attributed to the underlying cirrhosis. The aim of this study was to compare stage-matched prognosis after resection of FLC and non-cirrhotic HCC.
Methods: Stratified, stage-matched survival analysis compared the outcomes after resection of 74 consecutive patients with FLC and 158 non-cirrhotic patients with HCC. Patients were staged according to the 7th edition AJCC staging.
Results: The AJCC stage distributions for FLC and HCC demonstrated a predominance of stage IV disease in FLC and stage I in HCC (FLC stage I-26%, II-20%, III-11%, IV-43% vs. HCC stage I-42%, II-32%, III-20%, IV-6%, p<0.001). Among stage IV FLC patients, 84% had isolated nodal metastases, which did not affect overall survival (OS) or recurrence-free survival (RFS). In FLC, OS was significantly affected by number of tumors (5-year OS 65%, solitary tumor vs. 33%, multiple, p=0.006). Recurrent disease developed in 59 (80%) FLC patients and was treated with repeat surgical resection in 24 (41%) patients. Vascular invasion was the only independent factor associated with recurrent FLC, with 5-yr RFS rates of 9% and 21%, with and without vascular invasion (p=0.020). With respect to RFS, the AJCC staging did not stratify FLC patients, compared to non-cirrhotic HCC (figure).
Conclusion: When compared to non-cirrhotic HCC, patients with FLC are not adequately stratified by AJCC staging with respect to RFS. The AJCC designation of nodal metastases as stage IV does not apply to FLC. Important prognostic factors in FLC are the number of tumors and vascular invasion.
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