Association of severity in the grading of microvascular invasion with long-term oncological prognosis after liver resection for early-stage hepatocellular carcinoma: a multicenter retrospective cohort study from a hepatitis B virus-endemic area.
Association of severity in the grading of microvascular invasion with long-term oncological prognosis after liver resection for early-stage hepatocellular carcinoma: a multicenter retrospective cohort study from a hepatitis B virus-endemic area.
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DOI：
10.1097/js9.0000000000000325
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发表时间：
2023-04-01
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微血管侵犯(MVI)是影响肝细胞癌(HCC)术后复发和生存的重要恶性病理特征。本研究旨在探讨早期肝细胞癌患者MVI分级严重程度与肿瘤远期预后的关系。对2017年至2020年期间接受根治性切除的巴塞罗那临床肝癌0/A期患者的前瞻性维护的多中心数据库进行了回顾性研究。根据MVI的严重程度分为三组：M0(无MVI)、M1(发生MVI的1~5个部位)和M2(发生≤1~5个部位和/或发生≤1~1 cm的任何部位)。比较两组间的无复发生存率(RFS)和总生存率(OS)。在388例患者中，MVI分级的M0、M1和M2分别为223例(57.5%)、118例(30.4%)和47例(12.1%)。M0、M1和M2患者的中位OS和RFS分别为61.1月、52.7月和27.4月；43.0月、29.1月和13.1月(P均为0.001)。多变量分析表明，M1和M2都是OS[危险比(HR)：1.682，P=0.003；HR：3.570，P<；0.001]和RF(HR：1.550，P=0.037；HR：2.256，P<；0.001)的独立危险因素。MVI分级的严重程度与肝细胞癌切除后的复发和生存率独立相关。存在MVI的患者，特别是MVI分级(M2)较严重的患者，需要更严格的复发监测和/或积极的辅助治疗以防止复发。
The presence of microvascular invasion (MVI) is a significant malignant pathological feature related to recurrence and survival after liver resection for hepatocellular carcinoma (HCC). This study aimed to investigate the relationship between the severity in the grading of MVI and long-term oncological outcomes in patients with early-stage HCC. A retrospective study was conducted on a prospectively maintained multicenter database on patients who underwent curative resection for Barcelona Clinic Liver Cancer stage 0/A HCC between 2017 and 2020. Patients were classified into three groups according to the severity in the grading of MVI: M0 (no MVI), M1 (1–5 sites of MVI occurring ≤1 cm away from the tumor), and M2 (>5 sites occurring ≤1 cm and/or any site occurring >1 cm away from the tumor). Recurrence-free survival (RFS) and overall survival (OS) were compared among the groups. Of 388 patients, M0, M1, and M2 of the MVI gradings were present in 223 (57.5%), 118 (30.4%), and 47 (12.1%) patients, respectively. The median OS and RFS in patients with M0, M1, and M2 were 61.1, 52.7, and 27.4 months; and 43.0, 29.1, and 13.1 months (both P<0.001), respectively. Multivariable analyses identified both M1 and M2 to be independent risk factors for OS [hazard ratio (HR): 1.682, P=0.003; and HR: 3.570, P<0.001] and RFS (HR: 1.550, P=0.037; and HR: 2.256, P<0.001). The severity in the grading of MVI was independently associated with recurrence and survival after HCC resection. Patients with the presence of MVI, especially those with a more severe MVI grading (M2), require more stringent recurrence surveillance and/or active adjuvant therapy against recurrence.