Prediction of microvascular invasion before curative resection of hepatocellular carcinoma

Authors

  • Beom Kyung Kim MD,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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  • Kwang Hyub Han MD,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    2. Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
    3. Brain Korea 21 Project for Medical Science, Seoul, Republic of Korea
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  • Young Nyun Park MD, PhD,

    1. Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
    2. Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
    3. Brain Korea 21 Project for Medical Science, Seoul, Republic of Korea
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  • Mi Suk Park MD,

    1. Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
    2. Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
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  • Kyung Sik Kim MD, PhD,

    1. Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
    2. Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
    3. Brain Korea 21 Project for Medical Science, Seoul, Republic of Korea
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  • Jin Sub Choi MD,

    1. Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
    2. Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
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  • Byung Soo Moon MD,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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  • Chae Yoon Chon MD,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    2. Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
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  • Young Myoung Moon MD, PhD,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    2. Kwandong University College of Medicine, Seoul, Republic of Korea
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  • Sang Hoon Ahn MD, PhD

    Corresponding author
    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    2. Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
    • Department of Internal Medicine, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-gu, Seoul, Korea, 120-752. Fax: +82-2-393-6884.
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  • Kwang Hyub Han and Young Nyun Park contributed equally to this work.

Abstract

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.

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