Du Min, Chen Lingli, Zhao Jing, Tian Feng, Zeng Haiying, Tan Yunshan, Sun Huichuan, Zhou Jian, Ji Yuan
Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
BMC Cancer. 2014 Jan 24;14:38. doi: 10.1186/1471-2407-14-38.
Small hepatocellular carcinoma (SHCC) is a special type of hepatocellular carcinoma with the maximum tumor diameter ≤ 3 cm and excellent long-term outcomes. However, the prognostic factors for SHCC remain controversial. The purpose of this study is to clarify the predictive factors of SHCC.
The study population consisted of 458 patients underwent hepatectomy for single SHCC between January 2006 and December 2008. Clinical data (included age, gender, virus infection, serum alfa-fetoprotein level, cirrhosis, capsule, border), histopathologic features (included differentiation, morphology subtype, microvascular invasion, tumor infiltrative lymphocytes (TIL), inflammatory injury grade and fibrosis stage of surrounding liver), were evaluated to identify prognostic factors influencing SHCC patients' survival and microvascular invasion.
There were 384 males (83.8%) and 74 (16.2%) females with median ages of 52 years. The median progression-free survival (PFS) and overall survival (OS) durations were 53 and 54 months, respectively. About 91.9% (n = 421) SHCC were infected by Hepatitis B. One hundred forty-seven of the 446 (33.0%) patients with pre-operation serum AFP level record had serum alfa-fetoprotein (AFP) level ≥ 200 ug/ml and 178 of the 280 (63.8%) patients with post-operation serum AFP level record had AFP level ≥ 20 ug/ml. Liver cirrhosis was present in 411 cases (89.7%), while 434 (97.3%) tumors had clear border, and 250 (55.6%) tumors were encapsulated.MVI was identified in 83 patients (18.1%). In univariate analysis, a significant association between the presence of MVI and shortened PFS and OS was found (p = 0.012, 0.028, respectively). Histological differentiation had strong relationship with MVI (p = 0.009), in terms of MVI was more easily presented in patients with worse histological differentiation. In patients with MVI, worse survival was correlated with female patients, patients with G2 or G3 histological differentiation, pre-operation serum AFP level ≥ 200 ug/ml or post-operation serum AFP level ≥ 20 ug/ml, and TIL ≥ 50/HPF.
MVI is an independent poorer prognostic factor for PFS and OS of single SHCC patients. Tumor histological differentiation was closely related with MVI.
小肝细胞癌（SHCC）是肝细胞癌的一种特殊类型，最大肿瘤直径≤3 cm，长期预后良好。然而，SHCC的预后因素仍存在争议。本研究的目的是阐明SHCC的预测因素。
研究人群包括2006年1月至2008年12月期间因单发SHCC接受肝切除术的458例患者。评估临床数据（包括年龄、性别、病毒感染、血清甲胎蛋白水平、肝硬化、包膜、边界）、组织病理学特征（包括分化程度、形态学亚型、微血管侵犯、肿瘤浸润淋巴细胞（TIL）、周围肝脏的炎症损伤分级和纤维化阶段），以确定影响SHCC患者生存和微血管侵犯的预后因素。
共有384例男性（83.8%）和74例女性（16.2%），中位年龄为52岁。中位无进展生存期（PFS）和总生存期（OS）分别为53个月和54个月。约91.9%（n = 421）的SHCC感染了乙型肝炎。446例有术前血清AFP水平记录的患者中，147例（33.0%）血清甲胎蛋白（AFP）水平≥200 μg/ml；280例有术后血清AFP水平记录的患者中，178例（63.8%）AFP水平≥20 μg/ml。411例（89.7%）存在肝硬化，434例（97.3%）肿瘤边界清晰，250例（55.6%）肿瘤有包膜。83例患者（18.1%）发现有微血管侵犯（MVI）。单因素分析发现，MVI的存在与缩短的PFS和OS之间存在显著关联（分别为p = 0.012、0.028）。组织学分化与MVI密切相关（p = 0.009），就MVI更容易出现在组织学分化较差的患者中而言。在有MVI的患者中，较差的生存与女性患者、组织学分化为G2或G3的患者、术前血清AFP水平≥200 μg/ml或术后血清AFP水平≥20 μg/ml以及TIL≥50/HPF相关。
MVI是单发SHCC患者PFS和OS的独立预后不良因素。肿瘤组织学分化与MVI密切相关。
