Hepatocellular carcinoma in hepatectomized patients: biologic and therapeutic implications.

The macroscopic and microscopic features of 60 hepatocellular carcinomas (HCC) were investigated and correlated with patients' disease-free survival.The study included 60 HCCs removed, by partial hepatectomy, from an equal number of patients. In these tumors, several macroscopic and microscopic features were assessed, graded and correlated with disease-free survival.HCCs begin as small, well-differentiated tumors that have an increased proliferation rate and neovascularization. Vascular invasion, which is the strongest predictor of disease recurrence, correlated significantly with tumor number and size, the predominant and worst degree of differentiation, and the apoptosis/mitosis ratio. In the absence of macroscopic or large vessel invasion, the largest tumor size (p = 0.006), apoptosis/mitosis ratio (p = 0.03) and number of tumors (p = 0.04) were independent predictors of disease-free survival.This study showed that, in humans, the prognosis of HCC depends on several biological factors. Aggressive biological behavior (vascular invasion and recurrence) correlated significantly with: a) alterations in the apoptosis/mitosis ratio and b) architectural and cellular alterations.