Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
World J Surg. 2010 May;34(5):1034-8. doi: 10.1007/s00268-010-0424-5.
Microscopic vascular invasion is an important risk factor for recurrent hepatocellular carcinoma (HCC), even after curative liver resection or orthotopic liver transplantation. To predict microscopic portal venous invasion, the following two questions were examined retrospectively: Is it possible to detect microvascular invasion preoperatively? What are the characteristics of a group of early HCC recurrences even with no microvascular invasion?
Study 1 included 229 patients with HCC who underwent curative liver resection between 1991 and 2008; 127 had HCC without microscopic portal venous invasion, and 52 had HCC with microscopic portal venous invasion (MPVI). These two distinct groups were analyzed with regard to various clinicopathologic factors. Subsequently, we specifically investigated if HCCs <5 cm with vascular invasion (n = 32) have some characteristics that would allow detection of latent microvascular invasion. Study 2 included 127 HCC patients without MVPI; 42 had a recurrence within 2 years, and 85 patients were recurrence-free for at least 2 years. These two distinct groups were analyzed with regard to various clinicopathologic factors.
HCC diameter of >5 cm, the macroscopic appearance of HCC, and high levels of preoperative des-gamma-carboxyprothrombin are significant prognostic factors in identifying microvascular invasion of HCC. The strongest predictor of early recurrence (within 2 years) was the serum alpha-fetoprotein level in patients without clear microvascular invasion.
Tumor size, macroscopic appearance, and high tumor marker levels are important elements in identifying the group of patients with a low HCC recurrence rate after curative liver resection.
即使在根治性肝切除或原位肝移植后，微血管侵犯也是复发性肝细胞癌（HCC）的一个重要危险因素。为了预测微血管门静脉侵犯，我们回顾性地研究了以下两个问题：是否可以在术前检测到微血管侵犯？即使没有微血管侵犯，一组早期 HCC 复发的特征是什么？
研究 1 纳入了 1991 年至 2008 年间接受根治性肝切除术的 229 例 HCC 患者；其中 127 例 HCC 无显微镜下门静脉侵犯，52 例 HCC 有显微镜下门静脉侵犯（MPVI）。对这两组患者的各种临床病理因素进行了分析。随后，我们专门研究了是否 HCC 直径<5cm 伴血管侵犯（n=32）有一些特征可以检测到潜在的微血管侵犯。研究 2 纳入了 127 例无 MVPI 的 HCC 患者；其中 42 例在 2 年内复发，85 例至少 2 年无复发。对这两组患者的各种临床病理因素进行了分析。
HCC 直径>5cm、HCC 的大体外观和术前去γ-羧基凝血酶原水平是识别 HCC 微血管侵犯的重要预后因素。在无明显微血管侵犯的患者中，早期复发（2 年内）的最强预测因子是血清甲胎蛋白水平。
肿瘤大小、大体外观和高肿瘤标志物水平是识别根治性肝切除术后 HCC 复发率低的患者群体的重要因素。
