Milan Criteria, Multi-nodularity, and Microvascular Invasion Predict the Recurrence Patterns of Hepatocellular Carcinoma After Resection
Milan Criteria, Multi-nodularity, and Microvascular Invasion Predict the Recurrence Patterns of Hepatocellular Carcinoma After Resection
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DOI：
10.1007/s11605-012-2087-z
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发表时间：
2013-04-01
影响因子：
3.2
通讯作者：
Wu, Jaw-Ching
中科院分区：
文献类型：
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作者：
Hung, Hung-Hsu;Lei, Hao-Jan;Wu, Jaw-Ching
本研究旨在探讨肝细胞癌（HCC）手术切除（SR）后肿瘤复发超出米兰标准（MC）的危险因素，这些患者是相对禁忌行挽救性肝移植的患者。其中，分别有248例和199例患者符合米兰标准和超出米兰标准（BMC组）。总生存率、复发率和无病生存率采用多因素分析，中位随访34.4个月后，130例患者死亡。微血管浸润、肿瘤细胞Edmondson分期较高、BMC组和未接受抗病毒治疗与总生存率差相关。多结节、Edmondson分期高、BMC组和未抗病毒治疗是肿瘤复发的独立危险因素，而BMC组和未抗病毒治疗是无病生存的独立危险因素。米兰标准、多结节性和微血管浸润被用于将患者分为MC外肿瘤复发的低、中、高风险组，并显示出统计学意义（低对中，p = 0.011;低对高，p < 0.001; MC、多结节和微血管浸润的组合预测HCC的术后复发，并且可以为进一步治疗提供路线图。
This study aims to evaluate the risk factors for tumor recurrence beyond the Milan criteria (MC) for patients with hepatocellular carcinoma (HCC) after surgical resection (SR) in which salvage liver transplantation is relatively contraindicated.A total of 447 patients who underwent SR for HCC were enrolled consecutively. Among them, 248 and 199 patients were within the Milan criteria and beyond the Milan criteria (BMC group), respectively. Overall survival, recurrence, and disease-free survival were analyzed by multivariate analysis.After a median follow-up of 34.4 months, 130 patients died. Microvascular invasion, higher Edmondson stage of tumor cell differentiation, BMC group, and no anti-viral therapy were associated with poor overall survival. Multi-nodularity, higher Edmondson stage, BMC group, and no anti-viral therapy were independent risk factors for tumor recurrence, while BMC group and no anti-viral therapy were independent risk factors for disease-free survival. The Milan criteria, multi-nodularity, and microvascular invasion were used to stratify the patients into low-, medium-, and high-risk groups for tumor recurrence outside the MC and showed statistical significance (low vs. medium, p = 0.011; low vs. high, p < 0.001; medium vs. high, p = 0.009).The combination of the MC, multi-nodularity, and microvascular invasion predict the post-operative recurrence of HCC and may provide a roadmap for further treatment.