Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan.
Hum Pathol. 2011 Oct;42(10):1531-8. doi: 10.1016/j.humpath.2010.12.016. Epub 2011 Apr 14.
Portal venous invasion is one of the most important prognostic factors after surgical resection of hepatocellular carcinoma. Microscopic portal venous invasion can be evaluated histologically. We examined 280 hepatocellular carcinomas with microscopic portal venous invasion (n = 125) or without it (n = 155) for 3 characteristics: the number of invaded portal vessels, the maximum number of invading carcinoma cells, and the farthest distance from the tumor. Univariate analysis of overall and disease-free survival revealed that the number of invaded portal vessels and the number of invading carcinoma cells were poor prognostic factors. Therefore, we classified patients with microscopic portal venous invasion into 2 groups: a high-microscopic portal venous invasion group, in which there were multiple invaded portal venous vessels (≥2) and more than 50 invading carcinoma cells (n = 57), and a low-microscopic portal venous invasion group, in which microscopic portal venous invasion was observed but with invasion of only a single portal venous vessel or fewer than 50 invading carcinoma cells (n = 68). The high-microscopic portal venous invasion group showed significantly higher α-fetoprotein levels, larger tumor size, and higher frequencies of poorly differentiated histology, capsule infiltration, and intrahepatic metastasis compared with the low-microscopic portal venous invasion group (P = .0496, P < .0001, P = .0431, P = .0180, and P = .0012, respectively). The high-microscopic portal venous invasion group showed poorer overall survival and disease-free survival rates than the low-microscopic portal venous invasion group (P = .0004 and P = .0003), and the high-microscopic portal venous invasion group was an independent prognostic factor for disease-free survival (P = .0259). We proposed a new definition for classifying microscopic portal venous invasion and documented the necessity of definite histologic evaluation of it.
门静脉侵犯是肝癌手术后最重要的预后因素之一。可以通过组织学评估显微镜下的门静脉侵犯。我们检查了 280 例显微镜下有门静脉侵犯（n = 125）或无门静脉侵犯（n = 155）的肝细胞癌，评估了 3 个特征：受侵犯门静脉的数量、侵犯的癌细胞的最大数量以及肿瘤的最远距离。总生存和无病生存的单因素分析显示，受侵犯门静脉的数量和侵犯的癌细胞数量是不良预后因素。因此，我们将显微镜下有门静脉侵犯的患者分为 2 组：高显微镜下门静脉侵犯组，有多个受侵犯的门静脉（≥2 个）和超过 50 个侵犯的癌细胞（n = 57），以及低显微镜下门静脉侵犯组，仅观察到显微镜下门静脉侵犯，但只有单个门静脉受侵犯或侵犯的癌细胞少于 50 个（n = 68）。高显微镜下门静脉侵犯组的甲胎蛋白水平明显更高，肿瘤更大，低分化组织学、包膜浸润和肝内转移的频率更高，与低显微镜下门静脉侵犯组相比（P =.0496，P <.0001，P =.0431，P =.0180，P =.0012）。高显微镜下门静脉侵犯组的总生存率和无病生存率均低于低显微镜下门静脉侵犯组（P =.0004 和 P =.0003），高显微镜下门静脉侵犯组是无病生存率的独立预后因素（P =.0259）。我们提出了一种新的显微镜下门静脉侵犯分类定义，并记录了对其进行明确组织学评估的必要性。
