Influence of clear cell carcinoma on the post-hepatectomy prognosis of patients with hepatocellular carcinoma

Background: To evaluate whether the presence of clear cell carcinoma in patients with hepatocellular carcinoma affects their prognosis after hepatectomy. Methods: Data were retrospectively analyzed for 470 patients with hepatocellular carcinoma, of whom 239 also had clear cell carcinoma. All patients were treated by hepatectomy at our hospital between October 2007 and March 2020. Overall survival (OS) and disease-free survival (DFS) were compared between patients with or without clear cell carcinoma. A Cox proportional hazards model was used to identify factors independently associated with survival. A nomogram was formulated to predict long-term prognosis of patients with hepatocellular carcinoma containing clear cell carcinoma following hepatectomy. Results: The presence of clear cell carcinoma was associated with significantly higher DFS ( P  = 0.007) and OS ( P  < 0.001). Multivariate analysis identified the following factors as significantly associated with DFS: alpha-fetoprotein level (AFP), tumor size, liver cirrhosis, satellite nodules and portal vein tumor thrombosis (PVTT). The following factors were significantly associated with OS: tumor size, satellite nodules, capsule formation and Ki-67. A nomogram incorporating these independent prognostic factors showed a concordance index of 0.660 for predicting DFS and an index of 0.730 for predicting OS. Conclusion: Clear cell carcinoma is associated with better post-resection prognosis of patients with hepatocellular carcinoma. Tumor size and satellite nodules may be independent predictors of OS and DFS.