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Identification of 2 large size HCC phenotypes, with and without associated inflammation

Brian I Carr, Harika Gozukara Bag, Hikmet Akkiz, Ümit Karaoğullarından, Volkan Ince, Burak Isik and Sezai Yilmaz

Background: Large HCCs can often be associated with low levels of cirrhosis. However, inflammation is also regarded as a driver of HCC growth. Objectives: To compare patients with large >5 cm HCCs having high versus low serum inflammation parameters. Materials and methods: A Turkish patient HCC dataset with known survivals was retrospectively analyzed after dichotomization according to several clinical inflammation markers. Results: Amongst several parameters examined, only AST levels were significantly associated with elevated AFP levels and increased percent PVT and tumor multifocality. The dichotomization of the cohort according to high or low AST levels resulted in 2 subcohorts with a 5-fold difference in median survival. The 2 AST-dichotomised cohorts comprised patients with similar large-size HCCs, but which were significantly different with respect to serum AFP levels, percent PVT, and percent tumor multifocality. Conclusions: Two large-sized HCC phenotypes were identified. One had more aggressive HCC characteristics, higher inflammatory indices, and worse survival. The other had the opposite. Despite inflammation being important for the growth of some large tumors, others of a similar size likely have different growth mechanisms.