Pathological overview of steatohepatitic hepatocellular carcinoma in a surgical series

Abstract

AimsAccording to the last WHO classification, steatohepatitic hepatocellular carcinoma (SH‐HCC) is recognized as a distinct HCC subtype, even though a consensual definition is still lacking. The objectives of the study were to carefully describe the morphological features of SH‐HCC and evaluate its impact on prognosis.Methods and resultsWe conducted a single‐centre retrospective study including 297 surgically resected HCC. Pathological features including SH criteria (steatosis, ballooning, Mallory–Denk bodies, fibrosis, and inflammation) were assessed. SH‐HCC was defined by the presence of at least four of the five SH criteria and the SH component represented >50% of the tumour area. According to this definition, 39 (13%) HCC cases corresponded to SH‐HCC and 30 cases (10%) corresponded to HCC with an SH component (<50%). SH criteria in SH‐HCC and non–SH‐HCC were distributed as follows: ballooning (100% versus 11%), fibrosis (100% versus 81%), inflammation (100% versus 67%), steatosis (92% versus 8%), and Mallory–Denk bodies (74% versus 3%). Inflammation markers (c‐reactive protein [CRP] and serum amyloid A [SAA]) were significantly more expressed in SH‐HCC compared to non–SH‐HCC (82% versus 14%, P = <0.001). Five‐year recurrence‐free survival (RFS) and 5‐year overall survival (OS) were similar for SH‐HCC and non–SH‐HCC (P = 0.413 and P = 0.866, respectively). The percentage of SH component does not impact OS and RFS.ConclusionWe confirm in a large cohort the relatively high prevalence (13%) of SH‐HCC. Ballooning is the most specific criteria for this subtype. The percentage of the SH component does not impact prognosis.