title: Factors associated with outcomes and response to therapy in patients with infiltrative hepatocellular carcinoma.
abstract: OBJECTIVE
  Infiltrative hepatocellular carcinoma (iHCC) is characterized by its indistinct borders and lack of a typical pattern of contrast enhancement. There are few published data on iHCC. We assessed outcomes, effects of treatment, and prognostic factors in a large cohort of patients with iHCC.
  
  
  METHODS
  We analyzed data from 155 patients (median age, 60 years; 79% male; median level of α-fetoprotein, 347 ng/mL; median Model for End-Stage Liver Disease score, 13) with iHCC, on the basis of contrast-enhanced computed tomography or magnetic resonance imaging, from 2002-2010 at the University of California, San Francisco Medical Center. All imaging study results were independently reviewed by 2 investigators.
  
  
  RESULTS
  Most of the patients had tumors of Barcelona Clinic Liver Cancer stage C (70%) or D (22%). The median maximum tumor diameter was 11.3 cm; 41% of lesions were hypovascular, 82% had macrovascular invasion, and 52% had extrahepatic metastases. Median survival was 4.0 months, and rates of survival at 6 and 12 months were 30% and 10%, respectively. On multivariate analysis, predictors of 6-month mortality were Child-Pugh class B or C cirrhosis; lack of tumor-directed therapy with chemoembolization (transarterial chemoembolization), radiofrequency ablation, or sorafenib; α-fetoprotein level >1000 ng/mL; female sex; Model for End-Stage Liver Disease score; and maximum tumor diameter. The percentages of patients surviving 6 and 12 months were 17% and 2% for those who received no therapy (n = 109), 73% and 36% for those who received sorafenib (n = 11), and 45% and 17% for those who received transarterial chemoembolization (n = 18) (all P values <.01).
  
  
  CONCLUSIONS
  Infiltrative HCC is a radiographically distinct and advanced form of hepatocellular carcinoma with a poor prognosis. Therapy with transarterial chemoembolization or sorafenib appears to prolong survival and requires further investigation.
authors: Department of Medicine, University of California, San Francisco, San Francisco, California 94143-0538, USA.
authors: Neil
authors: N
authors: Mehta
authors: Nicholas
authors: N
authors: Fidelman
authors: Monika
authors: M
authors: Sarkar
authors: Francis Y
authors: FY
authors: Yao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008113:Liver Neoplasms / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012495:San Francisco; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult