title: Lymphoepithelioma-like hepatocellular carcinoma: an uncommon variant of hepatocellular carcinoma with favorable outcome.
abstract: Lymphoepithelioma-like hepatocellular carcinoma (LEL-HCC) is an uncommon variant of HCC with only 22 cases reported in the literature. To better determine the incidence, clinicopathologic features, prognostic significance, and molecular pathogenesis of LEL-HCC, we presented the largest series of LEL-HCC from a 9-year retrospective cohort of patients with HCC undergoing surgical resection. LEL-HCC was identified in 20 patients (4.9%). Compared with patients having HCC without significant tumor-infiltrating lymphocyte (TIL), patients with LEL-HCC had a relatively lower frequency of male sex (P=0.022), tended to present at early-stage disease (80.0% vs. 56.3% as AJCC stage I, P=0.037; 100% vs. 77.3% as BCLC stage 0/A, P=0.010), and all harbored a solitary tumor only (P=0.006). There was no significant difference in the age at presentation, underlying chronic liver disease, cirrhotic background, serum α-fetoprotein level, tumor size, histologic grade, and frequencies of vascular invasion. Most of the TILs in LEL-HCC were cytotoxic T lymphocytes. None of the LEL-HCCs was associated with Epstein-Barr virus. LEL-HCC was associated with better overall (5-y survival: 94.1% vs. 63.9%; P=0.007) and progression-free (5-y survival: 87.8% vs. 46.6%; P=0.002) survivals compared with HCC without significant TIL. The multivariate analysis revealed that LEL-HCC was an independent prognostic factor for overall and progression-free survivals. The adjusted hazard ratio of cancer death and tumor progression for LEL-HCC was 0.12 (P=0.037) and 0.14 (P=0.002), respectively. LEL-HCC did not differ in frequencies of microsatellite instability, BRAF mutation, and DNA hypermethylation. In brief, LEL-HCC is a distinct uncommon variant of HCC characterized by dense cytotoxic T-cell infiltration and favorable prognosis.
authors: Departments of *Anatomical and Cellular Pathology §Clinical Oncology, State Key Laboratory in Oncology in South China, Prince of Wales Hospital †Institute of Digestive Disease, Partner State Key Laboratory of Digestive Disease ‡Li Ka Shing Institute of Health Science, Sir Y.K. Pao Cancer Center ∥Department of Medicine and Therapeutics ¶Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, The Chinese University of Hong Kong, Hong Kong.
authors: Anthony W H
authors: AW
authors: Chan
authors: Joanna H M
authors: JH
authors: Tong
authors: Yi
authors: Y
authors: Pan
authors: Stephen L
authors: SL
authors: Chan
authors: Grace L H
authors: GL
authors: Wong
authors: Vincent W S
authors: VW
authors: Wong
authors: Paul B S
authors: PB
authors: Lai
authors: Ka-Fai
authors: KF
authors: To
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000235:genetics; D006528:Carcinoma, Hepatocellular / Q000145:classification / Q000235:genetics / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D005260:Female; D006723:Hong Kong; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000145:classification / Q000235:genetics / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D016246:Lymphocytes, Tumor-Infiltrating / Q000473:pathology; D008223:Lymphoma / Q000145:classification / Q000235:genetics / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013602:T-Lymphocytes, Cytotoxic / Q000473:pathology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor