Microvascular Invasion Is a Better Predictor of Tumor Recurrence and Overall Survival Following Surgical Resection for Hepatocellular Carcinoma Compared to the Milan Criteria
Microvascular Invasion Is a Better Predictor of Tumor Recurrence and Overall Survival Following Surgical Resection for Hepatocellular Carcinoma Compared to the Milan Criteria
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DOI：
10.1097/sla.0b013e31821ad884
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发表时间：
2011-07-01
影响因子：
9
通讯作者：
Tan, Say-Beng
中科院分区：
文献类型：
--
作者：
Lim, Kheng-Choon;Chow, Pierce Kah-Hoe;Tan, Say-Beng
目的：比较微血管侵犯（McVI）与米兰标准定义的参数在预测肝细胞癌（HCC）手术切除（SR）患者的肿瘤复发和总生存（OS）方面的作用。 背景数据摘要：虽然米兰标准对于选择肝移植和 HCC SR 结局良好的患者具有歧视性，但它既不能充分预测肿瘤复发，也不能解释肝功能良好患者的生存差异。 McVI 是 HCC 肝内转移的有力指标，但与米兰标准相比，其对于预测临床结果的相对意义尚不清楚。方法：对 2000 年 1 月至 2009 年 3 月在新加坡中央医院接受治疗性 SR 的患者进行长期结果随访，直至 2010 年 1 月 1 日。首先根据米兰标准对他们进行分层，然后根据 McVI 的存在情况进行分层，并与 OS 进行比较。结果：总而言之， 515 名患者中有 454 名接受了治愈性 SR。分为 4 组（Milan+、McVI-）、（Milan+、McVI+）、（Milan-、McVI-）和（Milan-、McVI+）。除(Milan+、McVI-)（1、3、5 年 OS，90%、73% 和 60%）与（Milan-、McVI-）（1、3、5 年 OS，86%、71% 和 61%）以及（Milan+、McVI+）与（Milan-、McVI+）外，各组之间与 OS 相关的所有成对比较均显着。多变量 Cox 回归分析显示，McVI 可预测 OS，之后 Milan 状态未添加额外的判别信息。 结论：在 HCC SR 后，McVI 比 Milan 标准更好地预测肿瘤复发和 OS。 McVI 评估应有助于患者选择辅助治疗，以改善 SR 后的预后。
Objective: To compare microvascular invasion (McVI) with parameters defined by the Milan criteria in predicting tumor recurrence and overall survival (OS) in patients with surgical resection (SR) for hepatocellular carcinoma (HCC).Summary Background Data: Although the Milan criteria is discriminatory for selecting patients with good outcomes in liver transplantation and SR for HCC, it neither adequately predict tumor recurrence nor explain differences in survival for patients with good liver function. McVI is a strong indicator of intrahepatic metastasis in HCC, but its relative significance for predicting clinical outcomes compared to the Milan criteria is unclear.Methods: Patients undergoing SR with curative intent from January 2000 to March 2009 at the Singapore General Hospital were followed up for long-term outcomes till January 1, 2010. They were stratified first by the Milan criteria and then by the presence of McVI and compared relative to OS.Results: Altogether, 454 of the 515 patients received curative SR. There were stratified into 4 groups (Milan+, McVI-), (Milan+, McVI+), (Milan-, McVI-), and (Milan-, McVI+). All pair-wise comparisons between groups relative to OS were significant except (Milan+, McVI-) (OS, 90%, 73%, and 60% at 1, 3, and 5 years) with (Milan-, McVI-) (OS, 86%, 71%, and 61% at 1, 3, 5 years) and (Milan+, McVI+) with (Milan-, McVI+). Multivariate Cox regression analysis showed that McVI was predictive of OS, after which Milan status did not add additional discriminative information.Conclusions: McVI is a better predictor of tumor recurrence and OS than the Milan criteria after SR for HCC. Assessment of McVI should aid in patient selection for adjuvant treatments to improve outcomes after SR.