Predictors of microvascular invasion in patients with hepatocellular carcinoma who are candidates for orthotopic liver transplantation
Predictors of microvascular invasion in patients with hepatocellular carcinoma who are candidates for orthotopic liver transplantation
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DOI：
10.1016/s1091-255x(01)00015-4
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发表时间：
2002-03-01
影响因子：
3.2
通讯作者：
Vauthey, JN
中科院分区：
文献类型：
--
作者：
Esnaola, NF;Lauwers, GY;Vauthey, JN
微血管侵犯影响肝细胞癌原位肝移植（OLT）后的生存。我们试图确定HCC患者术前微血管侵犯的预测因素，这些患者是OLT的候选者。从多机构数据库中确定了245例接受HCC切除术并符合OLT标准的患者（即单个肿瘤：5厘米或不超过3个小于或等于3厘米的肿瘤）。33%的患者有微血管侵犯的病理证据。30%的单发肿瘤患者和47%的多发肿瘤患者存在微血管侵犯（P = 0.04）。肿瘤小于或等于2 cm的患者中微血管侵袭率仅为25%，而肿瘤大于2 ~ 4 cm和大于4 cm的患者中微血管侵袭率分别为31%和50% （P = 0.01）。肿瘤分级与微血管侵袭高度相关：12%的高分化肿瘤患者有微血管侵袭，而29%和50%的中分化或低分化肿瘤患者有微血管侵袭（P < 0.001）。微血管侵袭的独立预测因子为肿瘤大小大于4 cm（比值比[OR]， 3.0, 95%可信区间[0]，1.2至7.1）和高肿瘤分级（OR, 6.3; 95% CI， 2.0至19.9）。肿瘤的大小和分级是微血管侵袭的有力预测指标。在移植前消融治疗时进行肿瘤活检并进行病理分级，可以改善HCC患者进行OLT的选择。
Microvascular invasion affects survival after orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC). We sought to identify preoperative predictors of microvascular invasion in patients with HCC who were candidates for OLT. A cohort of 245 patients who underwent resection for HCC and fulfilled the criteria for OLT (i.e., single tumors : 5 cm or no more than three tumors less than or equal to3 cm) were identified from a multi-institutional database. Thirty-three percent of the patients had pathologic evidence of microvascular invasion. Thirty percent of patients with single tumors and 47% with multiple tumors had microvascular invasion (P = 0.04). Only 25% of patients with tumors smaller than less than or equal to2 cm had microvascular invasion, compared to 31% and 50% with tumors greater than 2 to 4 cm or larger than 4 cm, respectively (P = 0.01). Tumor grade was highly correlated with microvascular invasion: 12% of patients with well-differentiated tumors had microvascular invasion, compared to 29% and 50% with moderately or poorly differentiated tumors, respectively (P < 0.001). The independent predictors of microvascular invasion were tumor size greater than 4 cm (odds ratio [OR], 3.0, 95% confidence interval [0], 1.2 to 7.1), and high tumor grade (OR, 6.3; 95% CI, 2.0 to 19.9). Tumor size and grade are strong predictors of microvascular invasion. A tumor biopsy with pathologic grading at the time of pretransplantation ablative therapy could improve selection of patients with HCC for OLT.