Predictive value of cell-in-cell phenomenon for postoperative recurrence of hepatocellular carcinoma

doi:10.3877/cma.j.issn.2095-3232.2021.03.020

Abstract

Abstract:

Objective

To evaluate the predictive value of cell-in-cell (CIC) phenomenon for the postoperative recurrence of hepatocellular carcinoma (HCC).

Methods

Clinical data of 79 patients who underwent hepatectomy for HCC in the Third Affiliated Hospital of Sun Yat-sen University from January 2014 to August 2019 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 69 patients were male and 10 female, aged from 26 to 78 years with a median age of 48 years. The tumor tissues were collected for HE staining and E-cadherin immunohistochemical staining. The number of CIC structure in HCC tissues was counted. The number of CIC between the HCC tissues and adjacent tissues was statistically compared by rank-sum test. Survival analysis was performed by Kaplan-Meier method and Log-rank test. The influence of CIC on the prognosis of HCC patients was analyzed by Cox's proportional hazard regression model. The nomogram for predicting recurrence-free survival was delineated according to the independent influencing factors.

Results

The median quantity of CIC in HCC tissues was 16.3(10.3, 21.7), significantly higher than 3.0(2.0, 4.3) in the adjacent tissues (Z=7.722, P<0.05). The 1-, 3- and 5-year recurrence-free survival rates in the high CIC group were 75.0%, 46.7% and 40.0%, significantly lower compared with 85.9%, 75.8% and 62.0% in the low CIC group, respectively (χ²=4.866, P<0.05). Multivariate Cox's analysis showed that the quantity of CIC≥16 in HCC tissues was an independent risk factor for the recurrence-free survival of HCC patients after operation (OR=2.984, 95%CI: 1.185-7.515; P<0.05). The nomogram demonstrated that the risk score was approximately 5.2 when the CIC quantity in HCC tissues was ≥16, secondary to the risk factors of large vessel invasion and female patients.

Conclusions

The quantity of CIC is increased in HCC tissues, which is an independent risk factor affecting the recurrence-free survival of HCC patients after hepatectomy. HCC patients with a quantity of CIC ≥16 present with higher recurrence rate and worse clinical prognosis.

Key words: Carcinoma, hepatocellular, Recurrence, Prognosis, Risk factors

Mingbin Deng, Tianxing Dai, Xu Lu, Guoying Wang. Predictive value of cell-in-cell phenomenon for postoperative recurrence of hepatocellular carcinoma[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2021, 10(03): 326-330.

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References 20

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项目	单因素分析			多因素分析
项目	OR	95%CI	P值	OR	95%CI	P值
性别女	3.211	1.376～7.495	0.007	3.516	1.211～10.208	0.021
球蛋白<25 g/L	1.691	0.849～3.366	0.135
HBV-DNA定量≥1 000 copies/ml	1.790	0.751～4.263	0.189	3.834	1.483～9.914	0.006
抗HBV治疗	0.487	0.225～1.053	0.068
肿瘤直径>5 cm	1.562	0.774～3.151	0.213	2.457	1.055～5.721	0.037
肿瘤数目多发	2.056	1.020～4.143	0.044
大血管侵犯	5.279	2.200～12.669	0.001	9.634	3.112～29.824	<0.001
微血管侵犯	1.774	0.826～3.810	0.142
TNM分期（Ⅲ/Ⅰ、Ⅱ期）	2.336	1.484～3.667	0.001
BCLC分期（中晚期/0期、早期）	2.599	1.647～4.100	0.001
癌组织CIC计数≥16个	2.355	1.093～5.073	0.029	2.984	1.185～7.515	0.020

项目	单因素分析			多因素分析
项目	OR	95%CI	P值	OR	95%CI	P值
性别女	3.211	1.376～7.495	0.007	3.516	1.211～10.208	0.021
球蛋白<25 g/L	1.691	0.849～3.366	0.135
HBV-DNA定量≥1 000 copies/ml	1.790	0.751～4.263	0.189	3.834	1.483～9.914	0.006
抗HBV治疗	0.487	0.225～1.053	0.068
肿瘤直径>5 cm	1.562	0.774～3.151	0.213	2.457	1.055～5.721	0.037
肿瘤数目多发	2.056	1.020～4.143	0.044
大血管侵犯	5.279	2.200～12.669	0.001	9.634	3.112～29.824	<0.001
微血管侵犯	1.774	0.826～3.810	0.142
TNM分期（Ⅲ/Ⅰ、Ⅱ期）	2.336	1.484～3.667	0.001
BCLC分期（中晚期/0期、早期）	2.599	1.647～4.100	0.001
癌组织CIC计数≥16个	2.355	1.093～5.073	0.029	2.984	1.185～7.515	0.020

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