Adachi E, Maeda T, Kajiyama K, Kinukawa N, Matsumata T, Sugimachi K, Tsuneyoshi M
Second Department of Pathology, Kyushu University, Fukuoka, Japan.
Cancer. 1996 May 15;77(10):2022-31. doi: 10.1002/(SICI)1097-0142(19960515)77:10<2022::AID-CNCR9>3.0.CO;2-S.
The postoperative intrahepatic recurrence of hepatocellular carcinoma (HCC) is high. It is difficult to distinguish whether the recurrence is metastatic or new primary lesion. To determine the malignant potential of HCC itself, we analyzed the risk factors associated with portal venous invasion since this is direct evidence of tumor invasiveness.
Two hundred and thirty-two patients who underwent curative hepatectomy for HCC without preoperative treatments were included in this study, because preoperative treatment caused the tumor to undergo a variety of histologic change. We analyzed the risk factors linked to portal venous invasion by both univariate and multivariate analyses.
In an univariate analysis, tumors larger than 3 cm, high histologic grade (III or IV), the presence of fibrous capsule, necrosis, mitotic rate of more than 4/10 high power fields, peliotic change, presence of tumor giant cells, high platelet count, low level of indocyanine green retention rate at 15 minutes, and the absence of cirrhosis were significantly correlated with portal venous invasion. In multiple stepwise logistic regression analysis, tumors larger than 3 cm, high histologic grades, and the presence of fibrous capsule were strong predictors of portal venous invasion by HCC.
Because the blood vessels of the fibrous capsule were frequently invaded by cancer cells, it may have been possible to prevent postoperative metastatic recurrence if HCC were resected before becoming large enough to have a fibrous capsule.
肝细胞癌（HCC）术后肝内复发率很高。很难区分复发是转移性的还是新的原发性病变。为了确定HCC本身的恶性潜能，我们分析了与门静脉侵犯相关的危险因素，因为这是肿瘤侵袭性的直接证据。
本研究纳入了232例未接受术前治疗而行根治性肝切除术治疗HCC的患者，因为术前治疗会使肿瘤发生多种组织学变化。我们通过单因素和多因素分析来分析与门静脉侵犯相关的危险因素。
在单因素分析中，肿瘤大于3 cm、高组织学分级（III或IV级）、存在纤维包膜、坏死、有丝分裂率超过4/10个高倍视野、紫癜样改变、存在肿瘤巨细胞、血小板计数高、15分钟时吲哚菁绿潴留率低以及无肝硬化与门静脉侵犯显著相关。在多步逻辑回归分析中，肿瘤大于3 cm、高组织学分级以及存在纤维包膜是HCC门静脉侵犯的强预测因素。
由于纤维包膜的血管常被癌细胞侵犯，如果在HCC形成足够大的纤维包膜之前进行切除，可能预防术后转移性复发。
