Yamashita Yo-Ichi, Imai Katsunori, Yusa Toshihiko, Nakao Yosuke, Kitano Yuki, Nakagawa Shigeki, Okabe Hirohisa, Chikamoto Akira, Ishiko Takatoshi, Yoshizumi Tomoharu, Aishima Shinichi, Maehara Yoshihiko, Baba Hideo
Department of Gastroenterological Surgery Graduate School of Medical Sciences Kumamoto University Kumamoto Japan.
Department of Surgery and Science Graduate School of Medical Sciences Kyushu University Fukuoka Japan.
Ann Gastroenterol Surg. 2018 Jan 8;2(3):197-203. doi: 10.1002/ags3.12057. eCollection 2018 May.
Small hepatocellular carcinomas (HCC ≤3 cm) are generally considered to have low malignant potential; however, some of them display pathological microvascular invasion (MVI).
Between 1991 and 2013, 414 patients with a single HCC ≤3 cm underwent curative hepatic resection (HR). Predictors for MVI were identified. Using another cohort (149 patients during 2000-2014), our predictors for MVI in HCC ≤3 cm were validated. In 428 patients with a single HCC ≤3 cm who had predictors for MVI, survival was compared among anatomical HR (n = 149), partial HR (n = 227), and radiofrequency ablation (RFA) (n = 52).
The positive rate of MVI reached 40.6% (168/414 patients). Independent predictors for MVI were as follows: tumor diameter ≥2 cm (odds ratio 1.84, =.0052), alpha-fetoprotein (AFP) ≥200 ng/mL (odds ratio 1.82, =.0466), and des-gamma-carboxy prothrombin (DCP) ≥40 mAU/mL (odds ratio 1.79, =.0126). Matching at least one predictor among these three could predict MVI in HCC ≤3 cm well (sensitivity 82.8%, positive predictive value [PPV] 48.7%). This criterion could also predict MVI in HCC ≤3 cm well in another cohort (sensitivity 82.8%, PPV 30.3%). In patients with single HCC ≤3 cm matching our criterion for predicting MVI, anatomical HR led to significantly better survival in both disease-free (hazard ratio 0.689, =.0231) and overall (hazard ratio 0.589, =.0316) survivals.
Matching at least one factor among three (tumor diameter ≥2 cm, AFP ≥200 ng/mL, or DCP ≥40 mAU/mL) can predict MVI in HCC ≤3 cm. In such patients, anatomical HR would be recommended to improve survival.
小肝细胞癌（HCC≤3 cm）通常被认为具有较低的恶性潜能；然而，其中一些显示出病理微血管侵犯（MVI）。
在1991年至2013年期间，414例单发HCC≤3 cm的患者接受了根治性肝切除术（HR）。确定了MVI的预测因素。使用另一队列（2000年至2014年期间的149例患者），对我们关于≤3 cm HCC中MVI的预测因素进行了验证。在428例具有MVI预测因素的单发HCC≤3 cm患者中，比较了解剖性HR（n = 149）、部分HR（n = 227）和射频消融（RFA）（n = 52）患者的生存率。
MVI阳性率达到40.6%（168/414例患者）。MVI的独立预测因素如下：肿瘤直径≥2 cm（比值比1.84，P = 0.0052）、甲胎蛋白（AFP）≥200 ng/mL（比值比1.82，P = 0.0466）和异常凝血酶原（DCP）≥40 mAU/mL（比值比1.79，P = 0.0126）。在这三个因素中匹配至少一个因素可以很好地预测≤3 cm HCC中的MVI（敏感性82.8%，阳性预测值[PPV]48.7%）。该标准在另一队列中也能很好地预测≤3 cm HCC中的MVI（敏感性82.8%，PPV 30.3%）。在单发HCC≤3 cm且符合我们预测MVI标准的患者中，解剖性HR在无病生存（风险比0.689，P = 0.0231）和总生存（风险比0.589，P = 0.0316）方面均导致显著更好的生存。
在三个因素（肿瘤直径≥2 cm、AFP≥200 ng/mL或DCP≥40 mAU/mL）中匹配至少一个因素可以预测≤3 cm HCC中的MVI。在此类患者中，建议进行解剖性HR以提高生存率。
