A system of classifying microvascular invasion to predict outcome after resection in patients with hepatocellular carcinoma.
A system of classifying microvascular invasion to predict outcome after resection in patients with hepatocellular carcinoma.
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DOI：
10.1053/j.gastro.2009.06.003
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发表时间：
2009-09
期刊：
影响因子：
29.4
通讯作者：
Schwartz ME
中科院分区：
文献类型：
--
作者：
Roayaie S;Blume IN;Thung SN;Guido M;Fiel MI;Hiotis S;Labow DM;Llovet JM;Schwartz ME
约70%的病例切除后肝细胞癌复发。肿瘤细胞对血管的侵袭可分为大体或微观(MVI)，是复发的危险因素。我们研究了一大批接受切除治疗的肝癌患者，以确定与复发和存活率相关的微血管侵犯的特征。我们回顾了1990年1月至2006年3月在西奈山医学院进行的所有肝细胞癌切除术的记录，以确定哪些患者患有MVI，这是通过组织学分析确定的。记录受累血管的数目和大小、侵犯肌壁的血管、与肿瘤的距离和卫星结节。在接受肝细胞癌切除术的384名患者中，131名(34.1%)符合入选标准。中位随访期28.9个月。复发68例，死亡54例。在多因素分析中，肌壁血管受侵预测复发(危险性比1.8，P=0.0 2)，肌壁血管受累(危险性比2.2，P=0.018)和距肿瘤1 cm以上血管受累(危险性比2.1，P=0.015)预示生存。为每个变量的存在指定分数的风险评分与复发(p=0.028)和生存率(p<；0.0001)相关。一种新的分类系统，包括侵犯肌壁的血管和侵犯距离肿瘤超过1厘米的血管，可以准确地预测肝细胞癌切除后MVI患者的复发风险和生存。
Hepatocellular carcinoma (HCC) recurs in approximately 70% of cases after resection. Vascular invasion by tumor cells can be classified as gross or microscopic (mVI) and is a risk factor for recurrence. We examined a large cohort of patients with HCC that were treated by resection to identify features of microvascular invasion that correlated with recurrence and survival. We reviewed the records of all HCC resections performed at the Mount Sinai School of Medicine between January 1990 and March 2006 to identify those with mVI, established by histological analysis. The numbers and sizes of vessels invaded, invasion of a vessel with a muscular wall, distance from the tumor, and satellite nodules were recorded. Of the 384 patients that underwent resection for HCC, 131 (34.1%) met the entry criteria. The median follow-up period was 28.9 mo. There were 68 recurrences and 54 deaths. In multivariate analysis, invasion of a vessel with a muscular wall predicted recurrence (hazard ratio 1.8, P=0.02); invasion of a vessel with a muscular wall (hazard ratio=2.2, P=0.018) and invasion of a vessel that was more than 1 cm from the tumor (hazard ratio=2.1, P=0.015) predicted survival. A risk score that assigned point for the presence of each variable was correlated with recurrence (p=0.028) and survival (p<0.0001). A novel classification system that includes invasion of a vessel with a muscular wall and invasion of a vessel that is more than 1 cm from the tumor can accurately predict risk of recurrence and survival of patients with mVI after HCC resection.
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