Okamura Yukiyasu, Sugiura Teiichi, Ito Takaaki, Yamamoto Yusuke, Ashida Ryo, Aramaki Takeshi, Uesaka Katsuhiko
Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 411-8777, Japan.
Division of Diagnostic Radiology, Shizuoka Cancer Center Hospital, Shizuoka, Japan.
World J Surg. 2018 Nov;42(11):3694-3704. doi: 10.1007/s00268-018-4658-y.
Previous studies have shown that microscopic vessel invasion (MVI) occurs in hepatocellular carcinoma (HCC) with a treatment history due to its poorer malignant behavior in comparison with primary HCC. The aim of the present study was to determine the predictors of MVI and overall survival in HCC patients with a treatment history.
This retrospective study included 580 patients who underwent hepatectomy and whose preoperative imaging showed no evidence of macroscopic vessel invasion. The patients were classified into two groups: primary HCC (n = 425) and HCC with a treatment history (n = 155). MVI was defined as the presence of either microscopic portal vein invasion or venous invasion, which was invisible on preoperative imaging.
MVI was identified in 34 (21.9%) patients with a treatment history. A multivariate analysis showed that a high des-gamma-carboxy prothrombin (odds ratio [OR] 5.16, P = 0.002) and a large tumor diameter (OR 2.57, P = 0.030) were the significant predictor of MVI in HCC with a treatment history. Moreover, the presence of MVI (hazard ratio [HR] 2.27, P = 0.001) and tumor diameter >27 mm (HR 2.04, P = 0.006) remained significant predictors of the overall survival in HCC with a treatment history. The tumor diameter cutoff value for predicting MVI (27 mm) in HCC with a treatment history was smaller than in primary HCC (37 mm).
The presence of MVI was a significant predictor in the HCC patients with a treatment history. The tumor diameter is an important factor that can be used to predict the presence of MVI, especially in HCC with a treatment history.
既往研究表明，与原发性肝细胞癌（HCC）相比，有治疗史的HCC因恶性行为更差而发生微血管侵犯（MVI）。本研究的目的是确定有治疗史的HCC患者中MVI和总生存的预测因素。
本回顾性研究纳入了580例行肝切除术且术前影像学检查未显示有肉眼可见血管侵犯证据的患者。患者分为两组：原发性HCC（n = 425）和有治疗史的HCC（n = 155）。MVI定义为术前影像学检查不可见的镜下门静脉侵犯或静脉侵犯。
在155例有治疗史的患者中，34例（21.9%）发现存在MVI。多因素分析显示，高异常凝血酶原（比值比[OR] 5.16，P = 0.002）和肿瘤直径大（OR 2.57，P = 0.030）是有治疗史的HCC患者发生MVI的显著预测因素。此外，MVI的存在（风险比[HR] 2.27，P = 0.001）和肿瘤直径>27 mm（HR 2.04，P = 0.006）仍是有治疗史的HCC患者总生存的显著预测因素。有治疗史的HCC患者中预测MVI的肿瘤直径临界值（27 mm）小于原发性HCC（37 mm）。
MVI的存在是有治疗史的HCC患者的显著预测因素。肿瘤直径是预测MVI存在的重要因素，尤其是在有治疗史的HCC患者中。
