To investigate clinicopathological characteristics of pedunculated hepatocellular carcinoma (PHCC) in different sites and the effects on postoperative intrahepatic recurrence and prognosis.

Clinical data of 87 PHCC patients admitted to The 909th Hospital from January 2017 to June 2019 were retrospectively analyzed. Among them, 51 patients were male and 36 female, aged from 41 to 69 years, with a median age of 54 years. The informed consents of all patients were obtained and the local ethical committee approval was received. All patients were divided into the diaphragmatic PHCC (n=39) and visceral PHCC groups (n=48) according to different tumor growth sites. The differences of pathological characteristics were analyzed between two groups. The postoperative 3-year intrahepatic recurrence rate and postoperative survival were also assessed. Univariate analysis and Logistic multivariate regression model were adopted to analyze the influencing factors of postoperative intrahepatic recurrence and prognosis of PHCC.

The incidence of clinical symptoms of diaphragmatic PHCC group was 64%(25/39), which was significantly higher than 39%(11/48) of visceral PHCC group (χ²=15.047, P<0.05). In the diaphragmatic PHCC group, there were 32 cases of PHCC diameter >8 cm, 17 cases of incisional margin ≤1 cm and 21 cases of microvascular invasion, and 16, 6, 8 cases in the visceral PHCC group accordingly, and the differences were statistically significant (χ²=5.720, 4.440, 5.228; P<0.05). The postoperative 3-year intrahepatic recurrence rate was 44%(38/87) and the mortality rate was 37%(32/87). Incomplete tumor encapsulation, incisional margin ≤1 cm, microvascular invasion and visceral surface growth were the independent influencing factors of postoperative 3-year intrahepatic recurrence (OR=2.113, 2.866, 3.025, 2.534; P<0.05). Tumor diameter>8 cm, incomplete tumor encapsulation, microvascular invasion and visceral surface growth were the independent influencing factors of postoperative 3-year mortality rate (OR=2.336, 2.857, 3.044, 2.758; P<0.05).

Patients with diaphragmatic PHCC present with early clinical symptoms, which can be identified during early stage. However, those with visceral PHCC develop large tumor diameter, high-risk microvascular invasion and low radical resection rate upon diagnosis. Patients with visceral PHCC have high postoperative intrahepatic recurrence and poor postoperative prognosis.