Clinicopathologic study on lymph node metastasis of hepatocellular carcinoma: a retrospective study of 660 consecutive autopsy cases.

There have been few reports in the literature concerning lymph node metastasis (LM) in hepatocellular carcinoma (HCC). Nowadays, hepatectomy has become one of the most popular treatments for HCC, and understanding LM in HCC is indispensable at surgery for improving the patient's prognosis. In the present study, the authors verified this using autopsy cases. The clinicopathologic characteristics of LM have been studied in 660 consecutive autopsy cases of HCC at Kurume University Hospital during the past 22 years. LM was noted in 168 (25.5%) of the 660 cases, and was most frequent (66.7%) in HCCs of the pedunculated type. The incidence of LM was significantly higher in the massive type of HCC (30.1%) than the nodular type (19.9%) (P < 0.05). The incidence of LM was also higher in non-cirrhotic (34.8%) than cirrhotic cases (23.5%) (P < 0.05). No metastasis was found in tumors less than 3 cm in diameter. The metastasis rate increased to 40% in tumors larger than 10 cm in diameter. The LM sites were peripancreatic, 13.6%; hepatic hilar, 13.5% and perigastric, 10.8%. The incidence of LM in the perigastric nodes was significantly higher in tumors located in the left hepatic lobe. LM was not found in well-differentiated HCCs but was frequently found in poorly-differentiated HCCs. Extensive LM was found in 60% of HCCs with sinusoidal tumor growth and in 57% of cases showing sarcomatous changes.