Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China; Department of General Surgery, Zhejiang Provincial Armed Police Corps Hospital, Hangzhou, Zhejiang, China.
Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China; Department of Hepatopancreatobiliary Surgical Oncology, Military Institution of Hepatopancreatobiliary Surgery, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.
HPB (Oxford). 2022 Jul;24(7):1063-1073. doi: 10.1016/j.hpb.2021.11.016. Epub 2021 Dec 3.
Microvascular invasion (MVI) is a risk factor of post-hepatectomy tumor recurrence for hepatocellular carcinoma (HCC). The patterns, treatments, and prognosis have not been documented in HCC patients with MVI.
A multicenter database of patients with HCC and MVI following resection was analyzed. The clinicopathological and initial operative data, timing and first sites of recurrence, recurrence management, and long-term survival outcomes were analyzed.
Of 1517 patients included, the median follow-up was 39.7 months. Tumor recurrence occurred in 928 patients, with 49% within 6 months of hepatectomy and 60% only in the liver. The incidence of intrahepatic only recurrence gradually increased with time after 6 months. Patients who developed recurrence within 6 months of hepatectomy had worse survival outcomes than those who developed recurrence later. Patients who developed intrahepatic only recurrence had better prognosis than those with either extrahepatic only recurrence or those with intra- and extrahepatic recurrence. Repeat resection of recurrence with curative intent resulted in better outcomes than other treatment modalities.
Post-hepatectomy tumor recurrence in patients with HCC and MVI had unique characteristics and recurrence patterns. Early detection of tumor recurrence and repeat liver resection with curative intent resulted in improved long-term survival outcomes.
微血管侵犯（MVI）是肝细胞癌（HCC）肝切除术后肿瘤复发的危险因素。在 MVI 肝癌患者中，尚未记录其模式、治疗和预后。
对接受 HCC 和 MVI 切除术后的患者进行多中心数据库分析。分析了临床病理和初始手术数据、复发的时间和首发部位、复发的管理以及长期生存结果。
在 1517 例患者中，中位随访时间为 39.7 个月。928 例患者发生肿瘤复发，其中 49%在肝切除术后 6 个月内，60%仅在肝脏内复发。肝内复发的发生率在 6 个月后逐渐随时间增加。肝切除术后 6 个月内发生复发的患者比以后发生复发的患者生存结局更差。仅肝内复发的患者比仅肝外复发或肝内外复发的患者预后更好。以治愈为目的的复发性肿瘤再次切除术的结果优于其他治疗方式。
MVI 肝癌患者肝切除术后的肿瘤复发具有独特的特征和复发模式。早期发现肿瘤复发并进行以治愈为目的的再次肝切除术可改善长期生存结果。
