Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China.
Int J Radiat Oncol Biol Phys. 2010 Feb 1;76(2):467-76. doi: 10.1016/j.ijrobp.2009.01.057. Epub 2009 May 4.
To evaluate the degree of invasion of hepatocellular carcinoma (HCC) microscopically that will provide a potential application for gross tumor volume to clinical tumor volume (GTV-to-CTV) expansion.
From January 2002 to January 2006, 149 HCC patients were selected from those who had undergone surgical resection. Pathology slides and clinical data of all patients were reviewed, including platelet counts, serum alpha-fetoprotein (AFP) levels, degree of liver cirrhosis, tumor size, capsular status, portal vein invasion, TNM stage, and histologic tumor grade. The distance between the tumor margin (or fibrous capsule) and the invasive lesions was measured by senior pathologists.
Of these 149 patients, 79 (53.0%) patients presented with tumor microinvasion between 0.5 and 4 mm. This degree of microinvasion was inversely correlated with lower platelet counts and positively correlated with higher AFP levels, larger tumor sizes, portal vein invasion, and advanced TNM stage. Microinvasion distances less than or equal to 2 mm were found in 96.1% of patients (74/77) with tumor dimensions less than or equal to 5 cm and in 94.5% of patients (85/90) with AFP levels less than 400 microg/l.
Based on our study findings, GTV-to-CTV expansions of 4 mm for HCC are required to conceal the gross tumor and any microscopic disease with 100% accuracy. Tumor size and AFP levels are the simplest indicators for determining the GTV-to-CTV distance for HCC.
评估肝癌（HCC）的微观侵袭程度，为肿瘤总体积到临床肿瘤体积（GTV-to-CTV）的扩展提供潜在的应用。
从 2002 年 1 月至 2006 年 1 月，从接受手术切除的患者中选择了 149 例 HCC 患者。回顾所有患者的病理切片和临床资料，包括血小板计数、血清甲胎蛋白（AFP）水平、肝硬化程度、肿瘤大小、包膜状态、门静脉侵犯、TNM 分期和组织学肿瘤分级。由资深病理学家测量肿瘤边缘（或纤维囊）与侵袭性病变之间的距离。
在这 149 例患者中，79 例（53.0%）患者存在 0.5 至 4 毫米的肿瘤微侵袭。这种程度的微侵袭与较低的血小板计数呈负相关，与较高的 AFP 水平、较大的肿瘤大小、门静脉侵犯和较晚期的 TNM 分期呈正相关。在肿瘤直径小于或等于 5 厘米的 77 例患者（96.1%）和 AFP 水平小于 400μg/l 的 90 例患者（94.5%）中，发现微侵袭距离小于或等于 2 毫米。
根据我们的研究结果，HCC 的 GTV-to-CTV 扩展需要以 100%的准确性掩盖大体肿瘤和任何微观疾病，肿瘤大小和 AFP 水平是确定 HCC GTV-to-CTV 距离的最简单指标。
