Microvascular invasion does not predict long-term survival in hepatocellular carcinoma up to 2 cm: reappraisal of the staging system for solitary tumors.
Microvascular invasion does not predict long-term survival in hepatocellular carcinoma up to 2 cm: reappraisal of the staging system for solitary tumors.
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DOI：
10.1245/s10434-012-2739-y
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发表时间：
2013-04
影响因子：
3.7
通讯作者：
Vauthey JN
中科院分区：
文献类型：
--
作者：
Shindoh J;Andreou A;Aloia TA;Zimmitti G;Lauwers GY;Laurent A;Nagorney DM;Belghiti J;Cherqui D;Poon RT;Kokudo N;Vauthey JN
最近报道了小（≤2 cm）肝细胞癌（HCC）患者的良好长期结局。然而，微血管浸润（MVI）在小肝癌中的意义尚不清楚。本研究的目的是确定MVI对2 cm以下小HCC的影响。在来自六个主要国际肝胆中心的1,109例孤立性HCC患者中，分析了MVI对小HCC（≤2 cm）患者和肿瘤大于2 cm患者长期生存率的影响。在小肝癌患者中，MVI不影响长期生存率（p = 0.8），而在较大肝癌患者中，观察到MVI患者的生存率明显较差（p < 0.0001）。在多变量分析中，（风险比[HR] 1.59; 95%置信区间（CI）1.27-1.99; p < 0.001），甲胎蛋白升高（HR 1.41; 95% CI 1.11-1.8; p = 0.005），组织学分级较高（HR 1.29; 95% CI 1.01-1.64; p = 0.04）是大于2 cm的HCC患者生存率较差的显著预测因子，但与小HCC的长期生存率无关。当队列被分为三组时-HCC ≤2，>2 cm无MVI，HCC >2 cm伴MVI-观察到显著的组间生存差异（p < 0.0001）。小肝癌预后良好，不受MVI的影响。第7版AJCC分类对孤立性HCC的区分能力可以通过根据肿瘤大小（≤2 cm vs.>2 cm）进行细分来进一步提高。
Excellent long-term outcomes have been reported recently for patients with small (≤2 cm) hepatocellular carcinoma (HCC). However, the significance of microvascular invasion (MVI) in small HCC remains unclear. The purpose of this study was to determine the impact of MVI in small HCC up to 2 cm. In 1,109 patients with solitary HCC from six major international hepatobiliary centers, the impact of MVI on long-term survival in patients with small HCC (≤2 cm) and patients with tumors larger than 2 cm was analyzed. In patients with small HCC, long-term survival was not affected by MVI (p = 0.8), whereas in patients with larger HCC, significantly worse survival was observed in patients with MVI (p < 0.0001). In multivariate analysis, MVI (hazard ratio [HR] 1.59; 95 % confidence interval (CI) 1.27–1.99; p < 0.001), elevated alpha-fetoprotein (HR 1.41; 95 % CI 1.11–1.8; p = 0.005), and higher histologic grade (HR 1.29; 95 % CI 1.01–1.64; p = 0.04) were significant predictors of worse survival in patients with HCC larger than 2 cm but were not correlated with long-term survival in small HCC. When the cohort was divided into three groups—HCC ≤2, >2 cm without MVI, and HCC >2 cm with MVI—significant between-group survival difference was observed (p < 0.0001). Small HCC is associated with an excellent prognosis that is not affected by the presence of MVI. The discriminatory power of the 7th edition of the AJCC classification for solitary HCC could be further improved by subdividing tumors according to size (≤2 vs. >2 cm).
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影响因子：
3.2
作者：
Cheng CH;Lee CF;Wu TH;Chan KM;Chou HS;Wu TJ;Yu MC;Chen TC;Lee WC;Chen MF
通讯作者：
Chen MF
影响因子：
1.9
作者：
Poon, Ronnie Tung-Ping;Fan, Sheung-Tat
通讯作者：
Fan, Sheung-Tat
DOI：
10.1016/j.jamcollsurg.2006.06.030
发表时间：
2006-10-01
影响因子：
5.2
作者：
Lei, Hao-Jan;Chau, Gar-Yang;Wu, Chew-Wun
通讯作者：
Wu, Chew-Wun
影响因子：
4.6
作者：
Sala, M;Fuster, J;Bruix, J
通讯作者：
Bruix, J
DOI：
10.1073/pnas.87.17.6791
发表时间：
1990-09-01
影响因子：
11.1
作者：
TSUDA, H;ZHANG, WD;HIROHASHI, S
通讯作者：
HIROHASHI, S