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01-04-2013 | Hepatobiliary Tumors

Microvascular Invasion Does Not Predict Long-Term Survival in Hepatocellular Carcinoma up to 2 cm: Reappraisal of the Staging System for Solitary Tumors

Authors: Junichi Shindoh, MD, PhD, Andreas Andreou, MD, Thomas A. Aloia, MD, Giuseppe Zimmitti, MD, Gregory Y. Lauwers, MD, Alexis Laurent, MD, David M. Nagorney, MD, Jacques Belghiti, MD, Daniel Cherqui, MD, Ronnie Tung-Ping Poon, MS, FRCS, Norihiro Kokudo, MD, PhD, Jean-Nicolas Vauthey, MD

Published in: Annals of Surgical Oncology | Issue 4/2013

Abstract

Background

Excellent long-term outcomes have been reported recently for patients with small (≤2 cm) hepatocellular carcinoma (HCC). However, the significance of microvascular invasion (MVI) in small HCC remains unclear. The purpose of this study was to determine the impact of MVI in small HCC up to 2 cm.

Methods

In 1,109 patients with solitary HCC from six major international hepatobiliary centers, the impact of MVI on long-term survival in patients with small HCC (≤2 cm) and patients with tumors larger than 2 cm was analyzed.

Results

In patients with small HCC, long-term survival was not affected by MVI (p = 0.8), whereas in patients with larger HCC, significantly worse survival was observed in patients with MVI (p < 0.0001). In multivariate analysis, MVI (hazard ratio [HR] 1.59; 95 % confidence interval (CI) 1.27–1.99; p < 0.001), elevated alpha-fetoprotein (HR 1.41; 95 % CI 1.11–1.8; p = 0.005), and higher histologic grade (HR 1.29; 95 % CI 1.01–1.64; p = 0.04) were significant predictors of worse survival in patients with HCC larger than 2 cm but were not correlated with long-term survival in small HCC. When the cohort was divided into three groups—HCC ≤2, >2 cm without MVI, and HCC >2 cm with MVI—significant between-group survival difference was observed (p < 0.0001).

Conclusions

Small HCC is associated with an excellent prognosis that is not affected by the presence of MVI. The discriminatory power of the 7th edition of the AJCC classification for solitary HCC could be further improved by subdividing tumors according to size (≤2 vs. >2 cm).

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Title: Microvascular Invasion Does Not Predict Long-Term Survival in Hepatocellular Carcinoma up to 2 cm: Reappraisal of the Staging System for Solitary Tumors
Authors: Junichi Shindoh, MD, PhD
Andreas Andreou, MD
Thomas A. Aloia, MD
Giuseppe Zimmitti, MD
Gregory Y. Lauwers, MD
Alexis Laurent, MD
David M. Nagorney, MD
Jacques Belghiti, MD
Daniel Cherqui, MD
Ronnie Tung-Ping Poon, MS, FRCS
Norihiro Kokudo, MD, PhD
Jean-Nicolas Vauthey, MD
Publication date: 01-04-2013
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 4/2013
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-012-2739-y

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Microvascular Invasion Does Not Predict Long-Term Survival in Hepatocellular Carcinoma up to 2 cm: Reappraisal of the Staging System for Solitary Tumors

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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