Abstract
BackgroundSmall hepatocellular carcinoma (SHCC) is a special type of hepatocellular carcinoma with the maximum tumor diameter ≤ 3 cm and excellent long-term outcomes. However, the prognostic factors for SHCC remain controversial. The purpose of this study is to clarify the predictive factors of SHCC.MethodsThe study population consisted of 458 patients underwent hepatectomy for single SHCC between January 2006 and December 2008. Clinical data (included age, gender, virus infection, serum alfa-fetoprotein level, cirrhosis, capsule, border), histopathologic features (included differentiation, morphology subtype, microvascular invasion, tumor infiltrative lymphocytes (TIL), inflammatory injury grade and fibrosis stage of surrounding liver), were evaluated to identify prognostic factors influencing SHCC patients’ survival and microvascular invasion.ResultsThere were 384 males (83.8%) and 74 (16.2%) females with median ages of 52 years. The median progression-free survival (PFS) and overall survival (OS) durations were 53 and 54 months, respectively. About 91.9% (n = 421) SHCC were infected by Hepatitis B. One hundred forty-seven of the 446 (33.0%) patients with pre-operation serum AFP level record had serum alfa-fetoprotein (AFP) level ≥ 200 ug/ml and 178 of the 280 (63.8%) patients with post-operation serum AFP level record had AFP level ≥ 20 ug/ml. Liver cirrhosis was present in 411 cases (89.7%), while 434 (97.3%) tumors had clear border, and 250 (55.6%) tumors were encapsulated.MVI was identified in 83 patients (18.1%). In univariate analysis, a significant association between the presence of MVI and shortened PFS and OS was found (p = 0.012, 0.028, respectively). Histological differentiation had strong relationship with MVI (p = 0.009), in terms of MVI was more easily presented in patients with worse histological differentiation. In patients with MVI, worse survival was correlated with female patients, patients with G2 or G3 histological differentiation, pre-operation serum AFP level ≥ 200 ug/ml or post-operation serum AFP level ≥ 20 ug/ml, and TIL ≥ 50/HPF.ConclusionsMVI is an independent poorer prognostic factor for PFS and OS of single SHCC patients. Tumor histological differentiation was closely related with MVI.
Highlights
Small hepatocellular carcinoma (SHCC) is a special type of hepatocellular carcinoma with the maximum tumor diameter ≤ 3 cm and excellent long-term outcomes
The following clinicopathological and surgical variables were evaluated for their influence on progression-free (PFS) and overall survival (OS): age, gender, disease etiology, alfa-fetoprotein (AFP) level, tumor capsule, border, histological differentiation, morphology subtype, fatty change, tumor infiltrative lymphocytes (TIL) microvascular invasion (MVI), inflammatory injury grade and fibrosis stage of surrounding liver
MVI was observed at a magnification of 200× with cluster tumor cells gathering in a vascular space with/without smooth muscle wall, and mixed with blood cells (Figure 1)
Summary
Small hepatocellular carcinoma (SHCC) is a special type of hepatocellular carcinoma with the maximum tumor diameter ≤ 3 cm and excellent long-term outcomes. Patients with solitary HCC up to 3cm has been reported to be less aggressive and characterized by excellent long-term outcomes after surgical resection in several studies. In addition to tumor size, worse histological differentiation, higher tumor stage, and presence of any of the following: microvascular invasion (MVI), intrahepatic metastasis, tumor rupture or portal venous invasion were significant risk factors for immediate post-operative recurrence of HCC [3]. Despite remarkable improvement in surgical techniques and perioperative management, the long-term outcome after resection of SHCC is far from satisfactory because of the higher postoperative recurrence. The present study was performed to identify the risk factors for recurrence and survival of SHCCs
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