Abstract
To identify the risk factors for the presence of microvascular invasion (MVI) in patients with solitary small hepatitis B related hepatocellular carcinoma (HCC). The data of 215 patients who underwent liver resection between 2008 and 2011 at our hospital were reviewed. MVI was confirmed on pathological examination in 41 patients. Preoperative risk factors for MVI were analyzed using uni- and multi-variate analyses. In the multivariate analysis, alpha-fetoprotein (AFP) greater than 400 ng/mL, tumor size and hypersplenism were independently associated with MVI. Receiver operating curve (ROC) analysis suggested the best cut-off value for tumor size was greater than 3.1 cm. The ROC curve analysis further identified patients with more than one above-mentioned risk factor may suffer from MVI with 75.6% sensitivity and 75.3% specificity. The recurrence-free and long-term survival rates of patients with MVI were significantly lower than patients without MVI. Patients with MVI may suffer from poor outcomes. AFP greater than 400 ng/mL, tumor size and hypersplenism were preoperative predictors of MVI in patients with solitary small hepatitis B related HCC.
Highlights
Hepatocellular carcinoma is the sixth most common cancer and third most frequent cancer-related death in the worldwide.[1]
The Receiver operating curve (ROC) curve analysis showed that the best cut-off value of tumor size for identifying Microvascular invasion (MVI) was greater than 3.1 cm with 92.93% sensitivity and 52.3% specificity
MVI is widely accepted as a strong prognostic factor for poor outcomes after liver resection and liver transplantation
Summary
Hepatocellular carcinoma is the sixth most common cancer and third most frequent cancer-related death in the worldwide.[1]. Many risk factors may contribute to the postoperative recurrence after curative liver resection, such as tumor size, tumor numbers, high preoperative AFP level and so forth.[3,4] Microvascular invasion (MVI) is a strong prognostic factor for HCC after liver resection, even after liver transplantation. A number of investigations suggested MVI impact significantly on long-term and recurrence-free survivals after liver resection and transplantation.[3,5] The cancer cells may have spread via the vasculature before liver resection or transplantation for HCC in patients with MVI.[6] Macrovascular invasion can be detected by preoperative imaging, different to macrovascular invasion, detection of MVI using preoperative radiological imaging still remains a difficulty.[7,8] Histological examination is still the only accurate method for assessing MVI until now.[9] previous investigations indicated tumor size may be a predictive factor for MVI, which contributes to MVI for patients with small HCC is still unclear.
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