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Clinical predictors of small solitary hepatitis B virus‐related hepatocellular carcinoma microinvasion
Author(s) -
Lu Wenping,
Tang Haowen,
Yang Zhanyu,
Jiang Kai,
Chen Yongliang,
Lu Shichun
Publication year - 2019
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.15403
Subject(s) - medicine , hepatocellular carcinoma , hepatitis b virus , hepatectomy , gastroenterology , viral load , hepatitis b , pathology , human immunodeficiency virus (hiv) , virus , surgery , resection , immunology
Background Microinvasion serves as a reliable indicator of poor prognosis after hepatectomy or transplantation for hepatocellular carcinoma (HCC). However, microinvasion is difficult to detect with current imaging modalities and is usually diagnosed histopathologically. The aim of this study is to identify the preoperative clinical predictors of microinvasion of small solitary hepatitis B virus (HBV)‐related HCC. Methods From January 2000 to December 2009, 110 patients with HBV‐related small primary solitary HCC (tumour diameter ≤3.0 cm) who underwent hepatectomy at Chinese PLA General Hospital were enrolled. The independent predictors of microinvasion, such as microvascular invasion and microscopic satellite nodules, were analysed. The prognosis of patients with microinvasion was compared with that of patients without microinvasion. Results Of the 110 patients, 31 (28.2%) exhibited microinvasion. Among them, 16 (51.6%) had microvascular invasion with microscopic satellite nodules, five (16.1%) had microscopic satellite nodules without microvascular invasion and 10 (32.3%) had microvascular invasion without microscopic satellite nodules. Two independent predictors of microinvasion were identified: serum alpha‐fetoprotein >20 ng/mL and a viral load of >10 4 copies/mL. Patients without microinvasion exhibited a significantly better prognostic outcome compared with those with microinvasion. Conclusion Regarding HBV‐related small HCC, patients presenting with alpha‐fetoprotein levels >20 ng/mL and a high viral load (HBV‐DNA >104 copies/mL) are at substantial risk for microinvasion.