Hepatic fibrosis influences the growth of hepatocellular carcinoma

Background/Aims: This study is designed to evaluate the hepatocellular carcinoma (HCC) growth under physical pressure due to fibrotic condition. Methodology: 206 patients with HCC who consulted our institute in the past 15 years were selected. The patients were separated into three or two groups according to liver function or hepatic fibrosis, respectively. The preoperative mean value of serum N-terminal procollagen type III (PIIINP) was estimated as an index of hepatic fibrosis. Results: 1) Poorly differentiated type of HCC tumor was significantly larger than the other types in cases with good-to-moderate liver function or without fibrosis. By contrast, in patients with poor liver function or fibrosis, no significant difference was found on tumor diameter (TD). 2) By contrast, although proliferating cell nuclear antigen labeling index (PCNALI) in cancer tissue was correlated with tumor diameter by simple linear regression analyses, PCNALI was consistently and significantly high in keeping with histological progression regardless of the status of liver functional or presence or absence of fibrosis. 3) The mean value of TD in intrahepatic metastasis (IM) positive cases, 45.8 +/- 5.1mm, was higher than the size in negative cases. And the mean TD in IM positive cases was significantly smaller in the cases with poor liver function and fibroses. 4). In patients with small tumor, IM was noted 34.5%, 37.0% and 43.8% in good, moderate and poor liver function group, respectively. PCNALI was significantly higher in cases with moderate-to-poor liver function group or hepatic fibrosis. Conclusions: In the cases with poor liver function or hepatic fibrosis, cell proliferation cycle might be always activated even if the tumor is small.