Clinicopathological features and prognosis of dual-phenotype hepatocellular carcinoma after curative hepatectomy: A propensity score matching analysis.

[BACKGROUND] Dual-phenotype hepatocellular carcinoma (DPHCC) is a recently defined subtype of hepatocellular carcinoma (HCC) characterized by the simultaneous hepatocellular and biliary epithelial marker expression. This study aimed to elucidate the clinicopathological features of DPHCC following curative liver resection and its relationship with prognosis.

[METHODS] We analyzed 1493 patients with HCC who underwent curative liver resection at the Peking Union Medical College Hospital from January 2013 to December 2023. All patients were divided into two groups according to immunohistochemical marker expression, with 487 and 1006 cases in the DPHCC and non-DPHCC groups, respectively. Propensity score matching was performed to reduce the deviation caused by baseline characteristics.

[RESULTS] After 1:2 matching (DPHCC/non-DPHCC group = 453/771), patients were comparable regarding all baseline characteristics. Compared to patients with non-DPHCC, those with DPHCC were significantly associated with poorer differentiation, microvascular invasion, satellite nodules, and bile duct tumor thrombus (P < 0.05). Patients with DPHCC also exhibited significantly worse recurrence-free survival (P = 0.009) and overall survival (P = 0.021). Furthermore, multivariate analysis revealed that DPHCC was an independent risk factor for recurrence-free survival (HR = 1.28, 95% CI: 1.05-1.52, P = 0.019) and overall survival (HR = 1.33, 95% CI: 1.15-1.51, P = 0.023).

[CONCLUSIONS] DPHCC, a newly proposed subtype of HCC, is associated with poorer clinicopathological features and adverse prognosis, providing important clinical guidance.