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Prediction of microvascular invasion before curative resection of hepatocellular carcinoma
Author(s) -
Kim Beom Kyung,
Han Kwang Hyub,
Park Young Nyun,
Park Mi Suk,
Kim Kyung Sik,
Choi Jin Sub,
Moon Byung Soo,
Chon Chae Yoon,
Moon Young Myoung,
Ahn Sang Hoon
Publication year - 2007
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.20953
Subject(s) - medicine , hepatocellular carcinoma , vascular invasion , radiology , hepatectomy , carcinoma , surgery , resection
Background The accurate staging of hepatocellular carcinoma (HCC) is important in establishing treatment strategies and prognosis. Among tumor factors, microvascular invasion, one of TNM staging components and prognostic factors, is underestimated preoperatively, due to inaccuracy of imaging modalities. We investigated preoperative predictors of microvascular invasion. Methods We reviewed 190 consecutive HCC patients given curative resection from 1999 to 2006. All were treatment‐naive and monitored every 3 months after resection. Tumor recurrence, survivals, and clinicopathological factors associated with microvascular invasion were analyzed. Results The 5‐year disease‐free survival (DFS) rate was 39.4%(median follow‐up duration: 35 months). On resection pathology, 38.9% (74/190 patients) had microvascular invasion undetected preoperatively, using liver spiral computed tomography (CT) or angiography. Independent predictors of microvascular invasion were tumor size ( P = 0.043), number ( P = 0.011), and Edmondson grade ( P = 0.001). Patients with Edmondson grade 1 and size <5 cm had no microvascular invasion, while those with grade ≥2 had higher incidences (7/18 patients, 38.8%) even in small tumor (<2 cm). When tumors recurred, presence of microvascular invasion independently increased incidences of multiple tumors, portal vein invasion, and diffuse‐infiltrative patterns significantly. Conclusions Preoperative predictors of microvascular invasion are tumor size, number, and Edmondson grade, which may be useful for making clinical decisions in both non‐surgical and surgical candidates. J. Surg. Oncol. 2008;97:246–252. © 2007 Wiley‐Liss, Inc.