Tumor size predicts vascular invasion and histologic grade: Implications for selection of surgical treatment for hepatocellular carcinoma
Tumor size predicts vascular invasion and histologic grade: Implications for selection of surgical treatment for hepatocellular carcinoma
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DOI：
10.1002/lt.20472
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发表时间：
2005-09-01
影响因子：
4.6
通讯作者：
Abdalla, EK
中科院分区：
文献类型：
--
作者：
Pawlik, TM;Delman, KA;Abdalla, EK
血管侵犯和高组织学分级预示着肝细胞癌(HCC)手术切除或肝移植后预后不良。尽管已知肿瘤大小和血管侵犯之间存在关联，但有一定比例的大肿瘤患者可以通过手术治疗获得良好的结果。阐明肿瘤大小、组织学分级和血管侵犯之间的关系对于切除和移植患者的选择具有重要意义。这项研究的目的是在1,073例接受肝细胞癌切除术的多中心国际数据库中，研究肝细胞癌肿瘤大小与显微(隐匿性)血管侵犯和组织学分级的关系。肿瘤直径越大(6.5 cm，63%)，微血管侵犯的发生率越高(P<；0.005)。肿瘤大小和数目是预测血管侵犯的重要因素。在所有肿瘤直径在5.1到6.5厘米之间的患者中，55%的患者有微小血管侵犯，而在肿瘤切开5个或更小的患者中，这一比例为31%(P<；0.001)。在仅有孤立性肿瘤的患者中，肿瘤直径在5.1%到6.5cm时微血管侵犯更为常见(41%)，而小于或小于5cm者中则有27%(P<；0.003)。肿瘤大小也预示着组织学分级：小于或等于5 cm的肿瘤为高级别的占36%，而5.1~6.5 cm的占54%(P=0.01)。组织学分级高、甲胎蛋白水平至少1000 ng/mL、多发肿瘤结节均可预测大于5厘米的肿瘤中的隐匿性血管侵犯。在将移植标准扩大到包括这些患者之前，应该考虑大于5 cm的肝细胞癌肿瘤中隐匿性血管侵犯的高发生率和晚期组织学分级，以及预后不良的生物学预测因素。
Vascular invasion and high histologic grade predict poor outcome after surgical resection or liver transplantation for hepatocellular carcinoma (HCC). Despite the known association between tumor size and vascular invasion, a proportion of patients with large tumors can be treated surgically with excellent outcomes. Clarification of the association between tumor size, histologic grade, and vascular invasion has implications for patient selection for resection and transplantation. The objective of this study was to examine the relationship between HCC tumor size and microscopic (occult) vascular invasion and histologic grade in a multicenter international database of 1,073 patients who underwent resection of HCC. The incidence of microscopic vascular invasion increased with tumor size ( 6.5 cm, 63%) (P < 0.005). Both size and number of tumors were important factors predicting vascular invasion. Among all patients with tumors 5.1 to 6.5 cm, microscopic vascular invasion was present in 55% compared with 31% for all patients with tumors 5 cut or smaller (P < 0.001). Among patients with solitary tumors only, microscopic vascular invasion was significantly more common in tumors measuring 5.1 to 6.5 cm (41%) compared with 27% of tumors 5 cm or smaller (P < 0.003). Tumor size also predicted histologic grade: 36% of tumors 5 cm or smaller were high grade, compared with 54% of lesions 5.1 to 6.5 cm (P = 0.01). High histologic grade, an alpha-fetoprotein level of at least 1000 ng/mL, and multiple tumor nodules each predicted occult vascular invasion in tumors larger than 5 cm. The high incidence of occult vascular invasion and advanced histologic grade in HCC tumors larger than 5 cm, as well as biologic predictors of poor prognosis, should be considered before criteria for transplantation are expanded to include these patients.