Microvascular invasion predicts a poor prognosis of solitary hepatocellular carcinoma up to 2 cm based on propensity score matching analysis
Microvascular invasion predicts a poor prognosis of solitary hepatocellular carcinoma up to 2 cm based on propensity score matching analysis
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DOI：
10.1111/hepr.13241
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发表时间：
2019-03-01
影响因子：
4.2
通讯作者：
Cong, Wen-Ming
中科院分区：
文献类型：
--
作者：
Wang, Han;Wu, Meng-Chao;Cong, Wen-Ming
目的美国癌症联合委员会第8版分期手册中未对直径达2cm的孤立性肝细胞癌（HCC）的微血管浸润（MVI）进行讨论。本研究旨在重新评估MVI对直径达2 cm的孤立性HCC的影响。方法2010年1月至2012年12月，对来自东部肝胆外科医院的496例HCC患者进行回顾性队列分析。进行倾向评分匹配以平衡基线特征。使用Kaplan-Meier方法进行生存分析。使用考克斯比例风险模型评价风险因素。采用多因素Logistic回归分析MVI的危险因素。结果所有患者分为MVI阴性组（n = 332）和MVI阳性组（n = 164）。倾向评分匹配前后，MRI阳性组的无复发生存率和总生存率均较差。多因素分析显示，MVI、男性、总胆红素水平、丙氨酸转氨酶水平和γ-谷氨酰转肽酶水平升高、白蛋白水平降低和HBV DNA载量>10（3）IU/mL是无复发生存的危险因素。MVI、高龄、低白蛋白水平和肝硬化是总生存率的危险因素。年龄20 ng/mL，和缺乏或不完整的包膜MVI的显着独立的预测。结论MVI的孤立性肝癌根治性肝切除术后的预后有负面影响，高达2厘米。第8版美国癌症联合委员会分期系统可根据MVI将孤立性HCC细分至2cm。
Aim Microvascular invasion (MVI) is not discussed for solitary hepatocellular carcinoma (HCC) up to 2 cm in the 8th Edition of the American Joint Committee on Cancer Staging Manual. The present study aimed to reappraise the influence of MVI on solitary HCC up to 2 cm in diameter.Methods Between January 2010 and December 2012, a retrospective cohort of 496 HCC patients from the Eastern Hepatobiliary Surgery Hospital was analyzed. Propensity score matching was carried out to balance the baseline characteristics. Survival analysis was carried out using the Kaplan-Meier method. Risk factors were evaluated using the Cox proportional hazards model. Multivariate logistic regression was used to identify the risk factors associated with MVI.Results All patients were classified into either an MVI-negative group (n = 332) or an MVI-positive group (n = 164). The MVI-positive group had poorer recurrence-free survival and overall survival before and after propensity score matching. The multivariate analysis showed that MVI; being male; increased total bilirubin levels, alanine transaminase levels and gamma-glutamyl transpeptidase levels; decreased albumin levels; and HBV DNA load >10(3) IU/mL were risk factors for recurrence-free survival. MVI, older age, lower albumin levels, and cirrhosis were risk factors for overall survival. Age 20 ng/mL, and lack of or an incomplete capsule were significantly independent predictors for MVI.Conclusions MVI had a negative impact on the prognosis of solitary HCC up to 2 cm after curative hepatectomy. The 8th edition of the American Joint Committee on Cancer staging system could be improved by subdividing solitary HCC up to 2 cm according to MVI.