Clinical Advances in Liver, Pancreas, and Biliary TractA System of Classifying Microvascular Invasion to Predict Outcome After Resection in Patients With Hepatocellular Carcinoma
Section snippets
Patients
We analyzed the prospectively collected data of a cohort of patients undergoing hepatic resection for HCC between January 1990 and March 2007 after obtaining approval from the Institutional Review Board. To have the outcomes affected primarily by tumor-related factors and not by the degree of underlying liver disease or portal hypertension, a homogenous study population was selected. Consequently, the inclusion criteria required patients to have Child–Pugh A liver function and platelet count
Results
During the study period, 385 patients underwent hepatic resection for treatment of HCC. Of these, 14 had either platelet count <100,000/μL or Child–Pugh B liver function, and they were excluded from analysis (Figure 2). No vascular invasion was detected in 109 (29%) of patients, whereas 151 (40%) had mVI, and 111 (30%) had gross vascular invasion on pathologic examination. The patient demographics, liver function, and tumor characteristics are provided in Table 1. Survival and recurrence were
Discussion
Hepatic resection for HCC can result in excellent long-term survival in properly selected patients. Nevertheless, resection continues to be plagued by a high rate of tumor recurrence. As our current study demonstrates, the large majority of recurrences is within the remaining liver. This is primarily because of intrahepatic dissemination of the tumor via the portal circulation. Consequently, it is not surprising that vascular invasion has been repeatedly identified as a predictor of recurrence
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Conflicts of interest The authors disclose no conflicts.
Funding Supported by grants from the U.S. National Institute of Diabetes and Digestive and Kidney Diseases (1R01DK076986-01; to J.L.), by the Samuel Waxman Cancer Research Foundation, by the Spanish National Health Institute (SAF-2007-61898), by Institut Catala de Recerca Avançada (ICREA), and by a grant from the National Institute of Health (K24 DK 60498-01; to M.E.S.).