Large Hypovascular Hepatocellular Carcinoma: Non-Classical Type

Objectives: As the frequency of surveillance protocols increases in patients with chronic liver disease, the rate of detection of radiologically atypical lesions such as hypovascular hepatocellular carcinoma (HCC) increases. There is no concensus regarding the frequency, size, differentiation, relationship with biomarkers, treatment and survival of hypovascular tumors.
To examine the clinical characteristics and clinical outcomes of resected hypovascular HCCs with known pathology.
Methods: Data of 62 HCC patients treated with resection between January 2009 and December 2022 were retrospectively examined. Twenty-five of these patients had radiological hypovascular HCC and 37 had hypervascular HCC. Patient characteristics (age, gender, blood count and liver function tests, and AFP), tumor variables (differentiation grade, portal vein invasion, Milan Status), and outcome variables (survival, recurrence) were compared between the two radiological groups.
Results: Comparison of quantitative variables between the 2 groups, showed that only GGT values were significantly higher in the hypovascular HCC group. There were no significant differences between the qualitative variables. Overall survival at 1, 3, and 5-years was 79.2%, 55.9%, and 51.2% in the hypovascular group and 83.1%, 61.8%, and 32.4% in the hypervascular group, respectively (p=0.517). Disease-free survival at 1, 3, and 5 years was 58.5%, 46% and 46% in the hypovascular group and 60.3%, 36.5% and 18.2% in the hypervascular group, respectively (p=0.572).
Conclusion: Unlike smaller HCCs, large-dimension hypovascular HCC cases were found to be biologically similar to hypervascular HCC cases. This result may be due to the larger size of the hypovascular tumors. There is a need for studies on bigger series of large size hypovascular HCC cases.