title: Histology obtained by needle biopsy gives additional information on the prognosis of hepatocellular carcinoma.
abstract: OBJECTIVE
  Hepatocellular carcinomas (HCC) have a strong biological heterogeneity. Current prognostic scores do not include histology. Information on the behavior of HCC based on histology has been characterized on retrospective data and large tissue specimens. We aimed to assess the additional value of needle biopsy and keratin 19 (K19) assessment in a prospective manner.
  
  
  METHODS
  Between 2003 and 2008, all patients with a confirmed diagnosis of HCC by a percutaneous or laparoscopic needle biopsy at the time of diagnosis, and of Barcelona Clinic Liver Cancer (BCLC) stage A, B or C, were included. The exclusion criterion was a palliative setting. Biopsies were scored for microvascular invasion, differentiation, K19, epithelial cell adhesion molecule and α-fetoprotein staining. Clinical and radiological features were registered at time of biopsy. The added value of K19 was assessed using Cox proportional hazards regression.
  
  
  RESULTS
  Of 74 patients screened, we included 58 patients. Based on the BCLC, 41% presented with early disease (BCLC A), 16% with intermediate disease (BCLC B) and 43% with advanced disease (BCLC C). In nine patients (16%), K19 staining was positive. Median follow up was 54 months (range 1-74) and 43 patients (72%) died. BCLC classification predicted the prognosis accurately, but histology offered additional prognostic information. In multivariate analysis, K19 was a strong predictor of overall survival (hazard ratio 4.57, 95% confidence interval 1.86-10.6), which improved predictive performance. No needle tract dissemination was observed.
  
  
  CONCLUSIONS
  Despite the possible problem of sampling error, needle biopsy offered additional prognostic information. This is especially the case for K19 staining.
authors.affiliation: Departments of Hepatology             Pathology             Radiology             Biostatistics Cell, Leuvens KankerinstituutDepartments of Abdominal Surgery             Abdominal Transplant Surgery, University Hospital Leuven             Department of Electrical Engineering (ESAT), Catholic University Leuven, Leuven, Belgium.
authors.forename: Hannah
authors.initials: H
authors.lastname: van Malenstein
authors.forename: Mina
authors.initials: M
authors.lastname: Komuta
authors.forename: Chris
authors.initials: C
authors.lastname: Verslype
authors.forename: Vincent
authors.initials: V
authors.lastname: Vandecaveye
authors.forename: Ben
authors.initials: B
authors.lastname: Van Calster
authors.forename: Baki
authors.initials: B
authors.lastname: Topal
authors.forename: Wim
authors.initials: W
authors.lastname: Laleman
authors.forename: David
authors.initials: D
authors.lastname: Cassiman
authors.forename: Werner
authors.initials: W
authors.lastname: Van Steenbergen
authors.forename: Raymond
authors.initials: R
authors.lastname: Aerts
authors.forename: Dirk
authors.initials: D
authors.lastname: Vanbeckevoort
authors.forename: Didier
authors.initials: D
authors.lastname: Bielen
authors.forename: Jacques
authors.initials: J
authors.lastname: Pirenne
authors.forename: Jos
authors.initials: J
authors.lastname: van Pelt
authors.forename: Tania
authors.initials: T
authors.lastname: Roskams
authors.forename: Frederik
authors.initials: F
authors.lastname: Nevens