Portolani Nazario, Baiocchi Gian Luca, Molfino Sarah, Benetti Anna, Gheza Federico, Giulini Stefano Maria
Department of Clinical and Experimental Sciences - Surgical Clinic, University of Brescia, Brescia, Italy.
World J Surg. 2014 Jul;38(7):1769-76. doi: 10.1007/s00268-013-2426-6.
Microvascular infiltration (MVI) is considered a necessary step in the metastatic evolution of hepatocellular carcinoma (HCC), but its prognostic value after liver resection (LR) is uncertain. We studied the clinical value of MVI compared to the Milan criteria in a consecutive series of patients submitted to radical LR.
A total of 441 patients were retrospectively evaluated. MVI and the Milan criteria were analyzed and compared as prognostic factors for overall and disease-free survival (DFS).
MVI was present in 189 patients (42.8 %). Grading, satellitosis, size of cancer, and alfa fetoprotein value were significantly related to MVI, which was present in 34.3 and 53.2 % of Milan+ and Milan- patients, respectively (p = 0.00001). Both MVI and the Milan criteria were associated with a lower overall and DFS, but only the Milan criteria were associated with the rate of early recurrence and the feasibility of a curative treatment of the recurrence. The application of MVI parameters to patients classified by the Milan criteria further selects the outcome in Milan+ patients (5-year survival rate of 54.1 and 67.9 %, respectively, in the presence or absence of MVI) but not in Milan- patients.
MVI is related to survival after LR for HCC, but the clinical value of this information is limited. In Milan+ patients, the absence of MVI selects the cases with better prognosis. In the presence of a liver recurrence, the Milan criteria related to the primary HCC show a better prognostic accuracy and have clinical relevance in the decision-making process.
微血管浸润（MVI）被认为是肝细胞癌（HCC）转移进展中的一个必要步骤，但其在肝切除（LR）后的预后价值尚不确定。我们在一系列接受根治性LR的患者中研究了MVI与米兰标准相比的临床价值。
对441例患者进行回顾性评估。分析并比较MVI和米兰标准作为总生存和无病生存（DFS）的预后因素。
189例患者（42.8%）存在MVI。分级、卫星灶、肿瘤大小和甲胎蛋白值与MVI显著相关，米兰标准符合组和不符合组中MVI的发生率分别为34.3%和53.2%（p = 0.00001）。MVI和米兰标准均与较低的总生存和DFS相关，但只有米兰标准与早期复发率及复发的治愈性治疗可行性相关。将MVI参数应用于按米兰标准分类的患者，进一步区分了米兰标准符合组患者的预后（有或无MVI时5年生存率分别为54.1%和67.9%），但对米兰标准不符合组患者无此作用。
MVI与HCC肝切除术后的生存相关，但该信息的临床价值有限。在米兰标准符合组患者中，无MVI提示预后较好。出现肝复发时，与原发性HCC相关的米兰标准显示出更好的预后准确性，且在决策过程中有临床意义。
