Date of Award

January 2019

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Tamar Taddei

Abstract

Macrotrabecular Massive (MTM-HCC) has been proposed as a new histological subtype of hepatocellular carcinoma (HCC). It has been previously shown to be associated with poorer clinical outcomes and aggressive tumor factors. This study aimed to further validate these findings by assessing the prognostic value of MT subtyping in post-resection and transplant patients. Review of 213 HCC cases from Yale New Haven Hospital showed 24 Macrotrabecular (MT-HCC) and 108 Conventional (CV-HCC) cases. Of these, 16 MT-HCC and 42 CV-HCC initial resection and transplant cases were identified. Clinical and pathologic features, recurrence, and overall survival data for these 58 cases were obtained. MT-HCC cases had higher recurrence, elevated alpha-fetoprotein levels, larger tumors, advanced Edmondson-Steiner nuclear grades and AJCC grades, and different etiological backgrounds compared to CV-HCC cases. Survival analysis revealed no significant difference in overall survival (p=0.165), with only recurrence as an independent risk factor (p=0.032). However, MT-HCC had poorer recurrence free survival (p=0.005), and MT-HCC (p=0.004) was a significant risk factor for recurrence. Overall, MT-HCC was associated with aggressive tumor characteristics and conferred a poorer recurrence free survival compared to CV-HCC cases independent of traditional poor prognostic markers such as vascular invasion. These results add to previous reports of MT-HCC characteristics, further suggesting that HCC showing MT pattern predominance may warrant closer follow-up post resection and transplantation

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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