Abstract
BackgroundThe presence of microvascular invasion (McVI) in hepatocellular carcinoma (HCC) has been proposed as a cause of recurrence and poor survival, although this has not been officially emphasized in staging systems. Thus, we conducted a retrospective study to investigate the prognostic importance of McVI in tumor staging in patients with HCC who underwent hepatic resection.MethodsA retrospective analysis was performed of patients who underwent hepatic resection for HCC at our center from 1994 to 2012. Patients with HCC were classified into four groups based on the presence of McVI and extent of gross vascular invasion (VI).ResultsThe 5-year overall and recurrence-free survival rates of 676 patients were 63.3 and 42.6%, respectively. There was no difference in tumor recurrence or survival rate between patients with HCC and McVI without gross VI and those with gross VI confined to segmental/sectional branches. Multivariate analysis revealed that the extent of VI based on the presence of McVI and gross VI was independently associated with tumor recurrence and overall survival.ConclusionsMcVI was revealed to be an important risk factor similar to gross VI confined to a segmental/sectional branch in patients with HCC who underwent hepatic resection. This finding should be considered when estimating the stage for prognosis.
Highlights
The presence of microvascular invasion (McVI) in hepatocellular carcinoma (HCC) has been proposed as a cause of recurrence and poor survival, this has not been officially emphasized in staging systems
According to the Barcelona Clinic for Liver Cancer (BCLC) staging, HCC with gross VI is classified as advanced stage, which most likely will not benefit from curative treatment [7]
The protocol developed by the College of American Pathologists considers McVI the same as gross VI confined to segmental/sectional branches of HCC on the current American Joint Committee on Cancer (AJCC)/International Union for Cancer Control (UICC) tumor tumor node metastasis (TNM) staging system [14]
Summary
The presence of microvascular invasion (McVI) in hepatocellular carcinoma (HCC) has been proposed as a cause of recurrence and poor survival, this has not been officially emphasized in staging systems. [1] treatment with curative intention, such as hepatic resection, liver transplantation (LT), and locoregional therapies, can only be applied in approximately 30% of patients with early-stage HCC [2] These therapeutic modalities have improved the overall survival (OS), longterm outcomes remain poor because of high rates of tumor recurrence. According to the Barcelona Clinic for Liver Cancer (BCLC) staging, HCC with gross VI is classified as advanced stage, which most likely will not benefit from curative treatment [7]. It remains unclear how much microvascular invasion (McVI) provides prognostic information for patients with HCC from the viewpoint of the extent of tumor invasion or extension
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