O. S. Eng1, M. Raoof1, P. Ituarte1, S. G. Warner1, G. Singh1, Y. Fong1, L. G. Melstrom1 1City Of Hope National Medical Center,Duarte, CA, USA
Introduction:
Fibrolamellar hepatocellular carcinoma (FLHC) is a unique entity compared to conventional hepatocellular carcinoma. The aim of this study was to examine post-resection outcomes and prognostic indicators for survival in this group of FLHC patients.
Methods:
A retrospective analysis of the National Cancer Database (NCDB) for patients with FLHC who had undergone resection from 2004-2014 was performed. Univariate and multivariate Cox proportional hazard models were used to identify factors associated with overall survival, and a prognostic nomogram was generated.
Results:
There were 197 patients identified, 171 (87%) of whom had long-term follow-up data. The mean age was 34 years (IQR 22-39), median tumor size was 9.2 cm (IQR 6.2-13.1), and 22% of patients had regional node-positive disease on final pathology. Univariate and multivariate analyses were performed using patient and tumor demographics with the outcome variable of overall survival. On multivariate analysis, age (HR 1.03, p=0.004), vascular invasion (HR 1.77, p=0.046), tumor size >7cm (HR 2.27, p=0.036), multifocal disease (HR 3.28, p=0.002), adjuvant chemotherapy (HR 2.27, p=0.020), and pN+ disease (HR 2.36, p=0.013) were all negative predictors of overall survival. A prognostic nomogram was generated (Figure 1). The c-statistic for the nomogram (0.710) was superior to that of AJCC staging (0.654).
Conclusion:
Independent predictors of decreased overall survival in patients with fibrolamellar hepatocellular carcinoma include age, vascular invasion, tumor size >7cm, multifocal disease, adjuvant chemotherapy, and pN+ disease. This is the first study to develop a nomogram for FLHC that may be a strong predictor of survival in future studies.
