肝细胞癌的节段性分布与接受移植的肝外植体中的微血管侵犯相关。
Segmental Distribution of Hepatocellular Carcinoma Correlates with Microvascular Invasion in Liver Explants Undergoing Transplantation.
作者信息
Al-Azzawi Yasir, Rouanet Eva, Hendrix Ryan J, Spaho Lidia, Malik Hesham, Devuni Deepika, Szabo Gyongyi, Barnard Graham
机构信息
Division of Gastroenterology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA.
Division of Surgical Oncology, Department of Surgery, University of Massachusetts Medical School, Worcester, MA 01655, USA.
出版信息
J Cancer Epidemiol. 2019 May 2;2019:8534372. doi: 10.1155/2019/8534372. eCollection 2019.
INTRODUCTION
Microvascular invasion (MVI) in hepatocellular carcinoma (HCC) patients is a poor prognostic factor after liver transplantation and/or resection. Any correlation between MVI and segmental location of HCC has yet to be studied. Our aim is to evaluate the segmental location of HCC and any correlation with the presence of MVI, portal vein thrombosis (PVT) in explanted livers, and the recurrence of HCC after transplantation. Another objective of the study is to assess the treatment history (ablation or transarterial chemoembolization (TACE)) and size of the tumor with respect to the risk of MVI.
METHODS
A single center, retrospective chart review, including 98 HCC patients, aged 18 years and older who had liver transplantation in our institute between 2012 and 2017. We reviewed the radiological images of the HCC tumors, the pathological findings of the explanted livers, and the follow-up imaging after transplantation.
RESULTS
98 patients with the diagnosis of HCC underwent liver transplantation between 2012 and 2017. The mean age of the cohort was 63 ± 8.2. Males represented 75% and Caucasian race represented 75% of the cohort. The most common etiology of cirrhosis was chronic hepatitis C virus infection followed by alcohol abuse and nonalcoholic steatohepatitis (NASH) with percentages of 50%, 23%, and 10%, respectively. Microvascular invasion was found in 16% of the patients while PVT and the recurrence of HCC were found in 17% and 6 % of the cohort, respectively. MVI was found in 10 single HCC and 6 multifocal HCC. Right lobe HCC had more MVI when compared to the left and multilobar HCC, with percentages of 11%, 2%, and 3%, respectively. Localization of HCC in segment 8 was associated with the highest percentage of MVI when compared to all other segments. The risk of MVI in segment 8 HCC was 3.5 times higher than the risk from the other segments (p=0.002) while no vascular invasion was found in segments 1, 3, and 5. The risk of vascular invasion in untreated HCC is 3 times the risk in treated HCC (P=0.03).
CONCLUSION
Our data indicate that the risk of microvascular invasion is highest in tumors localized to segment 8. The size and number of HCC tumors were not associated with an increased risk of microvascular invasion.
引言
肝细胞癌（HCC）患者的微血管侵犯（MVI）是肝移植和/或切除术后的不良预后因素。MVI与HCC的节段位置之间的任何相关性尚未得到研究。我们的目的是评估HCC的节段位置以及与MVI的存在、移植肝中门静脉血栓形成（PVT）和移植后HCC复发的任何相关性。该研究的另一个目的是评估治疗史（消融或经动脉化疗栓塞（TACE））以及肿瘤大小与MVI风险的关系。
方法
一项单中心回顾性病历审查，纳入了98例18岁及以上于2012年至2017年在我们研究所接受肝移植的HCC患者。我们回顾了HCC肿瘤的放射影像、移植肝的病理结果以及移植后的随访影像。
结果
98例诊断为HCC的患者在2012年至2017年期间接受了肝移植。该队列的平均年龄为63±8.2岁。男性占队列的75%，白种人占队列的75%。肝硬化最常见的病因是慢性丙型肝炎病毒感染，其次是酒精滥用和非酒精性脂肪性肝炎（NASH），分别占50%、23%和10%。16%的患者发现有微血管侵犯，而PVT和HCC复发分别在队列的17%和6%中发现。10例单发HCC和6例多发HCC发现有MVI。与左叶和多叶HCC相比，右叶HCC的MVI更多，分别为11%、2%和3%。与所有其他节段相比，HCC位于第8段时MVI的比例最高。第8段HCC的MVI风险比其他节段高3.5倍（p = 0.002），而在第1、3和5段未发现血管侵犯。未治疗的HCC的血管侵犯风险是治疗后HCC的3倍（P = 0.03）。
结论
我们的数据表明，位于第8段的肿瘤微血管侵犯风险最高。HCC肿瘤的大小和数量与微血管侵犯风险增加无关。
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