Centre Hépato-Biliaire, AP-HP, Hôpital Paul Brousse, Univ Paris Sud, Inserm U 935 and U 1193, 9 avenue Paul Vaillant Couturier, 94804, Villejuif, France.
Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan.
Ann Surg Oncol. 2019 Aug;26(8):2568-2576. doi: 10.1245/s10434-019-07365-0. Epub 2019 May 3.
There are few reports on microvascular invasion (MVI) located intra- or extratumorally and prognosis of hepatocellular carcinoma (HCC).
The aim of this study was to evaluate patient outcome according to the location of MVI, and to build a nomogram predicting extratumoral MVI.
We included 681 consecutive patients who underwent hepatic resection (HR) or liver transplantation (LT) for HCC from January 1994 to June 2012, and evaluated patient outcome according to the degree of vascular invasion (VI). A nomogram for predicting extratumoral MVI was created using 637 patients, excluding 44 patients with macrovascular invasion, and was validated using an internal (n = 273) and external patient cohort (n = 256).
The 681 patients were classified into four groups based on pathological examination (148 no VI, 33 intratumoral MVI, 84 extratumoral MVI, and 29 macrovascular invasion in patients who underwent HR; 238 no VI, 50 intratumoral MVI, 84 extratumoral MVI, and 15 macrovascular invasion in patients who underwent LT). Multivariate analysis revealed that extratumoral MVI was an independent risk factor for overall survival in patients who underwent HR (hazard ratio 2.62, p < 0.0001) or LT (hazard ratio 1.99, p = 0.0005). Multivariate logistic regression analysis identified six independent risk factors for extratumoral MVI: α-fetoprotein, tumor size, non-boundary type, alkaline phosphatase, neutrophil-to-lymphocyte ratio, and aspartate aminotransferase. The nomogram for predicting extratumoral MVI using these factors showed good concordance indices of 0.774 and 0.744 in the internal and external validation cohorts, respectively.
The prognostic value of MVI differs according to its invasiveness. The nomogram allows reliable prediction of extratumoral MVI in patients undergoing HR or LT.
关于位于肿瘤内或肿瘤外的微血管侵犯（MVI）及其对肝细胞癌（HCC）预后的影响，相关报道较少。
本研究旨在评估根据 MVI 位置患者的生存情况，并构建预测肿瘤外 MVI 的列线图。
本研究纳入了 1994 年 1 月至 2012 年 6 月期间接受肝切除术（HR）或肝移植术（LT）治疗 HCC 的 681 例连续患者，并根据血管侵犯程度（VI）评估患者的生存情况。使用 637 例患者（排除 44 例存在大血管侵犯的患者）建立预测肿瘤外 MVI 的列线图，并在内部（n=273）和外部患者队列（n=256）中进行验证。
681 例患者根据病理检查结果分为四组（HR 组：148 例无 VI，33 例肿瘤内 MVI，84 例肿瘤外 MVI，29 例存在大血管侵犯；LT 组：238 例无 VI，50 例肿瘤内 MVI，84 例肿瘤外 MVI，15 例存在大血管侵犯）。多因素分析显示，肿瘤外 MVI 是 HR（风险比 2.62，p<0.0001）或 LT（风险比 1.99，p=0.0005）患者总生存的独立危险因素。多因素 logistic 回归分析确定了肿瘤外 MVI 的六个独立危险因素：甲胎蛋白、肿瘤大小、非边界型、碱性磷酸酶、中性粒细胞与淋巴细胞比值和天冬氨酸氨基转移酶。使用这些因素构建的预测肿瘤外 MVI 的列线图在内部和外部验证队列中的一致性指数分别为 0.774 和 0.744。
MVI 的预后价值与其侵袭性有关。该列线图可用于可靠预测 HR 或 LT 患者的肿瘤外 MVI。
