Open Access Research article

Peritumoral ductular reaction: a poor postoperative prognostic factor for hepatocellular carcinoma

Minhui Xu12, Feng Xie3, Guangyang Qian2, Yingying Jing2, Shanshan Zhang2, Lu Gao2, Tao Zheng3, Mengchao Wu23, Jiamei Yang3* and Lixin Wei2*

Author Affiliations

1 The Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China

2 Tumor Immunology & Gene Therapy Center, Eastern Hepatobiliary Hospital, The Second Military Medical University, Changhai Road, Shanghai 200438, China

3 Department of Special Treatment and Liver Transplantation, Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai, China

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BMC Cancer 2014, 14:65  doi:10.1186/1471-2407-14-65

Published: 5 February 2014



The role of ductular reaction (DR) in hepatocellular carcinoma (HCC) remains to be elucidated.


In this study, we tried to uncover possible effect by correlating peritumoral DR in a necroinflammatory microenvironment with postoperative prognosis in HCC. The expression of peritumoral DR/CK19 by immunohistochemistry, necroinflammation and fibrosis were assessed from 106 patients receiving curative resection for HCC. Prognostic values for these and other clinicopathologic factors were evaluated.


Peritumoral DR significantly correlated with necroinflammation (r = 0.563, p = 3.4E-10), fibrosis (r = 0.435, p = 3.1E-06), AFP level (p = 0.010), HBsAg (p = 4.9E-4), BCLC stage (p = 0.003), TNM stage (p = 0.002), multiple nodules (p = 0.004), absence of tumor capsule (p = 0.027), severe microscopic vascular invasion (p = 0.031) and early recurrence (p = 0.010). Increased DR was significantly associated with decreased RFS/OS (p = 4.8E-04 and p = 2.6E-05, respectively) in univariate analysis and were identified as an independent prognostic factor (HR = 2.380, 95% CI = 1.250-4.534, p = 0.008 for RFS; HR = 4.294, 95% CI = 2.255-8.177, p = 9.3E-6 for OS) in multivariate analysis.


These results suggested that peritumoral DR in a necroinflammatory microenvironment was a poor prognostic factor for HCC after resection.

Ductular reaction (DR); Hepatic progenitor cells (HPCs); Necroinflammation; Fibrosis; Hepatocellular carcinoma (HCC); Prognosis