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01-08-2017 | Original Scientific Report

Clinicopathological Characteristics of Hepatocellular Carcinoma with Microscopic Portal Venous Invasion and the Role of Anatomical Liver Resection in These Cases

Authors: Shingo Shimada, Toshiya Kamiyama, Hideki Yokoo, Tatsuya Orimo, Kenji Wakayama, Takahiro Einama, Tatsuhiko Kakisaka, Hirofumi Kamachi, Akinobu Taketomi

Published in: World Journal of Surgery | Issue 8/2017

Abstract

Background

The aims of this study were to investigate predictive factors for microscopic portal venous invasion (mPVI) in hepatocellular carcinoma (HCC) and whether anatomical liver resection (ALR) was useful in such cases.

Methods

We analyzed 852 patients with HCC without macroscopic portal venous invasion who were treated at our hospital between January 1990 and May 2014. These patients were stratified into a microscopic portal venous invasion group (mPVI group; n = 153) and non-microscopic portal venous invasion group (NmPVI group; n = 699).

Results

PIVKA-II ≥100 mAU/ml, a tumor size ≥5 cm, a confluent lesion, and poor differentiation were found to be independent risk factors for mPVI. Among the mPVI group who had single HCC under 5 cm, serum albumin level <4.0 g/dl, PIVKA-II ≥100 mAU/ml, a positive surgical margin, and non-ALR (NALR) were independent unfavorable prognostic factors for overall survival (OS). PIVKA-II ≥100 mAU/ml, a positive surgical margin and NALR were independent unfavorable prognostic factors for relapse-free survival (RFS). ALR was significantly favorable factor for both OS and RFS of the mPVI group who had single HCC under 5 cm.

Conclusions

Even if no portal venous invasion is detectable in HCC patients preoperatively, a PIVKA-II ≥100 mAU/ml, tumor size ≥5 cm, and a confluent lesion indicate a high risk of mPVI. ALR should be considered for the patients with these characteristics because it is a favorable prognostic factor in these cases with mPVI.

Ahmed F, Perz JF, Kwong S et al (2008) National trends and disparities in the incidence of hepatocellular carcinoma 1998–2003. Prev Chronic Dis 5(3):A74PubMedPubMedCentral

Arii S, Tanaka J, Yamazoe Y et al (1992) Predictive factors for intrahepatic recurrence of hepatocellular carcinoma after partial hepatectomy. Cancer 69(4):913–919CrossRefPubMed

Ikai I, Arii S, Kojiro M et al (2004) Reevaluation of prognostic factors for survival after liver resection in patients with hepatocellular carcinoma in a Japanese nationwide survey. Canser 101(4):796–802

Nelson RC, Chezmar JL, Sugarbaker PH et al (1990) Preoperative localization of focal liver lesions to specific liver segments: utility of CT during arterial portography. Radiology 176(1):89–94CrossRefPubMed

Bach AM, Hann LE, Brown KT et al (1996) Portal vein evaluation with US: comparison to angiography combined with CT arterial portography. Radiology 201(1):149–154CrossRefPubMed

Hann LE, Schwartz LH, Panicek DM et al (1998) Tumor involvement in hepatic veins: comparison of MR imaging and US for preoperative assessment. Radiology 206(3):651–656CrossRefPubMed

Tsai TJ, Chau GY, Lui WY et al (2000) Clinical significance of microscopic tumor venous invasion in patients with resectable hepatocellular carcinoma. Surgery 127(6):603–608CrossRefPubMed

Shirabe K, Kajiyama K, Harimoto N et al (2009) Prognosis of hepatocellular carcinoma accompanied by microscopic portal vein invasion. World J Gastroenterol 15(21):2632–2637CrossRefPubMedPubMedCentral

Eguchi S, Takatsuki M, Hidaka M et al (2010) Predictor for histological microvascular invasion of hepatocellular carcinoma: a lesson from 229 consecutive cases of curative liver resection. World J Surg 34(5):1034–1038. doi:10.1007/s00268-010-0424-5 CrossRefPubMed

10.

Fujita N, Aishima S, Iguchi T et al (2011) Histologic classification of microscopic portal venous invasion to predict prognosis in hepatocellular carcinoma. Hum Pathol 42(10):1531–1538CrossRefPubMed

11.

Fuks D, Dokmak S, Paradis V et al (2012) Benefit of initial resection of hepatocellular carcinoma followed by transplantation in case of recurrence: an intention-to-treat analysis. Hepatology 55(1):132–140CrossRefPubMed

12.

Nanashima A, Tobinaga S, Kunizaki M et al (2010) Strategy of treatment for hepatocellular carcinomas with vascular infiltration in patients undergoing hepatectomy. J Surg Oncol 101(7):557–563CrossRefPubMed

13.

Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196CrossRefPubMed

14.

Kamiyama T, Nakanishi K, Yokoo H et al (2010) Perioperative management of hepatic resection toward zero mortality and morbidity: analysis of 793 consecutive cases in a single institution. J Am Coll Surg 211(4):443–449CrossRefPubMed

15.

Kim SU, Jung KS, Lee S et al (2014) Histological subclassification of cirrhosis can predict recurrence after curative resection of hepatocellular carcinoma. Liver Int 34(7):1008–1017CrossRefPubMed

16.

Mitsunobu M, Toyosaka A, Oriyama T et al (1996) Intrahepatic metastases in hepatocellular carcinoma: the role of the portal vein as an efferent vessel. Clin Exp Metastasis 14(6):520–529CrossRefPubMed

17.

Shirabe K, Itoh S, Yoshizumi T et al (2007) The predictors of microvascular invasion in candidates for liver transplantation with hepatocellular carcinoma: with special reference to the serum levels of des-gamma-carboxy prothrombin. J Surg Oncol 95(3):235–240CrossRefPubMed

18.

Shirabe K, Kajiyama K, Abe T et al (2009) Predictors of microscopic portal vein invasion by hepatocellular carcinoma: measurement of portal perfusion defect area ratio. J Gastroenterol Hepatol 24(8):1431–1436CrossRefPubMed

19.

Adachi E, Maeda T, Kajiyama K et al (1996) Factors correlated with portal venous invasion by hepatocellular carcinoma. Cancer 77(10):2022–2031CrossRefPubMed

20.

Kenmochi K, Sugihara S, Kojiro M (1987) Relationship of histologic grade of hepatocellular carcinoma (HCC) to tumor size, and demonstration of tumor cells of multiple different grade in single small HCC. Liver 7(1):18–26CrossRefPubMed

21.

Hu Z, Zhou J, Wang H et al (2013) Survival in liver transplant recipients with hepatitis B- or hepatitis C-associated hepatocellular carcinoma: the chinese experience from 1999 to 2010. PLoS ONE 8(4):e61620CrossRefPubMedPubMedCentral

22.

Hiotis SP, Rahbari NN, Villanueva GA et al (2012) Hepatitis B vs. hepatitis C infection on viral hepatitis-associated hepatocellular carcinoma. BMC Gastroenterol 12:64CrossRefPubMedPubMedCentral

23.

Belghiti J, Panis Y, Farges O et al (1991) Intrahepatic recurrence after resection of hepatocellular carcinoma complicating cirrhosis. Ann Surg 214(2):114–117CrossRefPubMedPubMedCentral

24.

Fan ST, Ng IO, Poon RT et al (1999) Hepatectomy for hepatocellular carcinoma: the surgeon’s role in long-term survival. Arch Surg 134(10):1124–1130CrossRefPubMed

25.

Lau H, Fan ST, Ng IO et al (1998) Long term prognosis after hepatectomy for hepatocellular carcinoma: a survival analysis of 204 consecutive patients. Cancer 83(11):2302–2311CrossRefPubMed

26.

Matsumata T, Kanematsu T, Takenaka K et al (1989) Patterns of intrahepatic recurrence after curative resection of hepatocellular carcinoma. Hepatology 9(3):457–460CrossRefPubMed

27.

Jwo SC, Chiu JH, Chau GY et al (1992) Risk factors linked to tumor recurrence of human hepatocellular carcinoma after hepatic resection. Hepatology 16(6):1367–1371CrossRefPubMed

28.

Yamamoto J, Kosuge T, Takayama T et al (1996) Recurrence of hepatocellular carcinoma after surgery. Br J Surg 83(9):1219–1222CrossRefPubMed

29.

Nagao T, Inoue S, Yoshimi F et al (1990) Postoperative recurrence of hepatocellular carcinoma. Ann Surg 211(1):28–33CrossRefPubMedPubMedCentral

30.

Poon RT, Fan ST, Ng IO et al (2000) Different risk factors and prognosis for early and late intrahepatic recurrence after resection of hepatocellular carcinoma. Hepatology 89(3):500–507

31.

Hasegawa K, Kokudo N, Imamura H et al (2005) Prognostic impact of anatomic resection for hepatocellular carcinoma. Ann Surg 242(2):252–259CrossRefPubMedPubMedCentral

32.

Okamura Y, Ito T, Sugiura T et al (2014) Anatomic versus nonanatomic hepatectomy for a solitary hepatocellular carcinoma. J Gastrointest Surg 18(11):1994–2002CrossRefPubMed

33.

Marubashi S, Gotoh K, Akita H et al (2015) Anatomical versus non-anatomical resection for hepatocellular carcinoma. Br J Surg 102(7):776–784CrossRefPubMed

34.

Kobayashi A, Miyagawa S, Miwa S et al (2008) Prognostic impact of anatomical resection on early and late intrahepatic recurrence in patients with hepatocellular carcinoma. J Hepatobiliary Pancreat Surg 15(5):515–521CrossRefPubMed

35.

Matsumoto T, Kubota K, Aoki T et al (2016) Clinical impact of anatomical liver resection for hepatocellular carcinoma with pathologically proven portal vein invasion. World J Surg 40(2):402–411. doi:10.1007/s00268-015-3231-1 CrossRefPubMed

36.

Yamashita Y, Imai D, Bekki Y et al (2014) Surgical outcomes of anatomical resection for solitary recurrent hepatocellular carcinoma. Anticancer Res 34(8):4421–4426PubMed

Title: Clinicopathological Characteristics of Hepatocellular Carcinoma with Microscopic Portal Venous Invasion and the Role of Anatomical Liver Resection in These Cases
Authors: Shingo Shimada
Toshiya Kamiyama
Hideki Yokoo
Tatsuya Orimo
Kenji Wakayama
Takahiro Einama
Tatsuhiko Kakisaka
Hirofumi Kamachi
Akinobu Taketomi
Publication date: 01-08-2017
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 8/2017
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-017-3964-0

At a glance: The STEP trials

Springer Medicine

Clinicopathological Characteristics of Hepatocellular Carcinoma with Microscopic Portal Venous Invasion and the Role of Anatomical Liver Resection in These Cases

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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