Kim Beom Kyung, Han Kwang Hyub, Park Young Nyun, Park Mi Suk, Kim Kyung Sik, Choi Jin Sub, Moon Byung Soo, Chon Chae Yoon, Moon Young Myoung, Ahn Sang Hoon
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
J Surg Oncol. 2008 Mar 1;97(3):246-52. doi: 10.1002/jso.20953.
The accurate staging of hepatocellular carcinoma (HCC) is important in establishing treatment strategies and prognosis. Among tumor factors, microvascular invasion, one of TNM staging components and prognostic factors, is underestimated preoperatively, due to inaccuracy of imaging modalities. We investigated preoperative predictors of microvascular invasion.
We reviewed 190 consecutive HCC patients given curative resection from 1999 to 2006. All were treatment-naive and monitored every 3 months after resection. Tumor recurrence, survivals, and clinicopathological factors associated with microvascular invasion were analyzed.
The 5-year disease-free survival (DFS) rate was 39.4%(median follow-up duration: 35 months). On resection pathology, 38.9% (74/190 patients) had microvascular invasion undetected preoperatively, using liver spiral computed tomography (CT) or angiography. Independent predictors of microvascular invasion were tumor size (P = 0.043), number (P = 0.011), and Edmondson grade (P = 0.001). Patients with Edmondson grade 1 and size <5 cm had no microvascular invasion, while those with grade > or =2 had higher incidences (7/18 patients, 38.8%) even in small tumor (<2 cm). When tumors recurred, presence of microvascular invasion independently increased incidences of multiple tumors, portal vein invasion, and diffuse-infiltrative patterns significantly.
Preoperative predictors of microvascular invasion are tumor size, number, and Edmondson grade, which may be useful for making clinical decisions in both non-surgical and surgical candidates.
肝细胞癌（HCC）的准确分期对于制定治疗策略和判断预后至关重要。在肿瘤相关因素中，微血管侵犯作为TNM分期的组成部分和预后因素之一，由于影像学检查方法的不准确，术前常被低估。我们对微血管侵犯的术前预测因素进行了研究。
我们回顾了1999年至2006年间连续接受根治性切除的190例HCC患者。所有患者均未接受过治疗，术后每3个月进行一次监测。分析了与微血管侵犯相关的肿瘤复发、生存情况及临床病理因素。
5年无病生存率（DFS）为39.4%（中位随访时间：35个月）。在切除病理检查中，使用肝脏螺旋计算机断层扫描（CT）或血管造影术，术前未检测到微血管侵犯的患者占38.9%（74/190例）。微血管侵犯的独立预测因素为肿瘤大小（P = 0.043）、数量（P = 0.011）和Edmondson分级（P = 0.001）。Edmondson 1级且肿瘤大小<5 cm的患者无微血管侵犯，而Edmondson分级≥2级的患者，即使肿瘤较小（<2 cm），微血管侵犯的发生率也较高（7/18例，38.8%）。当肿瘤复发时，微血管侵犯的存在独立地显著增加了多发肿瘤、门静脉侵犯和弥漫浸润型的发生率。
微血管侵犯的术前预测因素为肿瘤大小、数量和Edmondson分级，这可能有助于为非手术和手术候选患者做出临床决策。
