title: Infiltrative Hepatocellular Carcinoma: Natural History and Comparison with Multifocal, Nodular Hepatocellular Carcinoma.
abstract: OBJECTIVE
  The purpose of this study was to delineate infiltrating hepatocellular carcinoma (HCC) and to compare patient characteristics, tumor characteristics, and outcomes with patients presenting with HCC tumors of discrete, nodular morphology at a similar stage.
  
  
  METHODS
  Patient demographic and tumor characteristics of 224 patients diagnosed with infiltrative or advanced discrete, nodular HCC at the University of Texas Southwestern Medical Center were collected between January 2005 and December 2011. Patient demographics, tumor characteristics, treatment regimens, and overall survival were analyzed between the two groups.
  
  
  RESULTS
  Overall, 135 patients were diagnosed with infiltrative HCC compared with 89 patients with either T3a or T3b nodular, discrete HCC. Infiltrative HCC patients were more likely to have symptoms at presentation compared with the nodular HCC cohort, (95 vs. 78 %; p < 0.001). No difference in underlying liver function or etiology of liver disease between cohorts was observed. Patients with infiltrative HCC were more likely to have metastatic disease (53 vs. 35 %; p = 0.007) and malignant venous thrombus (75 vs. 62 %; p < 0.001) compared with the nodular group. Infiltrative HCC had a median survival of 1.9 months compared with 4.3 months in the nodular HCC group (p < 0.0001). Within the infiltrative HCC cohort, symptoms [hazard ratio (HR) 7.2, 95 % confidence interval (CI) 1.9-27], Child-Pugh class C (HR 3.9, 95 % CI 2.1-7.1), hepatic thrombus (HR 5.6, 95 % CI 1.9-16), and lack of treatment (HR 5.6, 95 % CI 2.1-14.6) were associated with worse survival.
  
  
  CONCLUSIONS
  Infiltrative HCC had a worse outcome than nodular, discrete HCC most likely secondary to burden of tumor manifested by extrahepatic metastases, vascular invasion, higher α-fetoprotein levels, and a high degree of symptoms.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA. adam.yopp@utsouthwestern.edu.|Department of Medicine, University of Texas Southwestern Medical Center and Parkland Health and Hospital System, Dallas, TX, USA. adam.yopp@utsouthwestern.edu.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Yopp
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Mokdad
authors.affiliation: Division of Medical Oncology, University of Texas Southwestern Medical Center and Parkland Health and Hospital System, Dallas, TX, USA.
authors.forename: Hao
authors.initials: H
authors.lastname: Zhu
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: John C
authors.initials: JC
authors.lastname: Mansour
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Glen C
authors.initials: GC
authors.lastname: Balch
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Choti
authors.affiliation: Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center and Parkland Health and Hospital System, Dallas, TX, USA.
authors.forename: Amit G
authors.initials: AG
authors.lastname: Singal
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000378:metabolism / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000378:metabolism / Q000556:secondary*; D008198:Lymph Nodes / Q000378:metabolism / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D000509:alpha-Fetoproteins