Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225 Changhai Road, Shanghai, 200433, China.
Department of General Surgery, Zhejiang Provincial Armed Police Corps Hospital, Hangzhou, Zhejiang, China.
Hepatol Int. 2021 Jun;15(3):642-650. doi: 10.1007/s12072-021-10174-x. Epub 2021 Apr 5.
Microvascular invasion (MVI) is a risk factor for postoperative survival outcomes for hepatocellular carcinoma (HCC) after liver resection (LR). This study aims to investigate the actual long-term survival and its associated prognostic factors after LR for HCC patients with MVI.
This study was conducted on HCC patients with MVI who underwent LR from January 2009 to December 2012 at five major hospitals in China. The patients were divided into the 'long-term survivor group' and the 'short-term survivor group'. The clinicopathologic characteristics, perioperative data and survival outcomes were compared between these two groups. Univariate and multivariate regression analyses were performed to identify predictive factors associated with long-term survival outcomes.
The study included 1517 patients with an actual 5-year survival rate of 33.3%. Multivariate regression analysis revealed that HBV DNA > 10 IU/mL, alanine aminotransferase > 44 U/L, alpha-fetoprotein > 400 ng/ml, anatomical hepatectomy, varices, intraoperative blood loss > 400 ml, tumor diameter > 5 cm, tumor number, satellite nodules, tumor encapsulation, wide resection margin and adjuvant transarterial chemoembolization (TACE) were independent prognostic factors associated with actual long-term survival.
One-third of HCC patients with MVI reached the long-term survival milestone of 5 years after resection. Anatomical hepatectomy, controlling intraoperative blood loss, a wide resection margin, and postoperative adjuvant TACE should be considered for patients to achieve better long-term survival outcomes.
微血管侵犯（MVI）是肝癌（HCC）患者行肝切除（LR）术后生存结局的危险因素。本研究旨在探讨 HCC 合并 MVI 患者行 LR 后的实际长期生存及其相关预后因素。
本研究纳入了 2009 年 1 月至 2012 年 12 月在中国五家大型医院行 LR 的 HCC 合并 MVI 患者。将患者分为“长期生存组”和“短期生存组”。比较两组患者的临床病理特征、围手术期数据和生存结局。采用单因素和多因素回归分析确定与长期生存结局相关的预测因素。
本研究共纳入 1517 例患者，实际 5 年生存率为 33.3%。多因素回归分析显示，HBV DNA>10IU/ml、丙氨酸氨基转移酶>44U/L、甲胎蛋白>400ng/ml、解剖性肝切除术、静脉曲张、术中出血量>400ml、肿瘤直径>5cm、肿瘤数目、卫星结节、肿瘤包膜、广泛切除边缘和辅助经动脉化疗栓塞（TACE）是与实际长期生存相关的独立预后因素。
三分之一的 HCC 合并 MVI 患者在切除后达到了 5 年的长期生存里程碑。对于患者来说，解剖性肝切除术、控制术中出血量、广泛切除边缘和术后辅助 TACE 应被视为实现更好长期生存结局的考虑因素。
