Annals of Surgical Oncology

, Volume 20, Issue 4, pp 1223–1229

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
    • International Cooperative Study Group on Hepatocellular Carcinoma, Department of Surgical OncologyThe University of Texas MD Anderson Cancer Center
  • Andreas Andreou
    • International Cooperative Study Group on Hepatocellular Carcinoma, Department of Surgical OncologyThe University of Texas MD Anderson Cancer Center
  • Thomas A. Aloia
    • International Cooperative Study Group on Hepatocellular Carcinoma, Department of Surgical OncologyThe University of Texas MD Anderson Cancer Center
  • Giuseppe Zimmitti
    • International Cooperative Study Group on Hepatocellular Carcinoma, Department of Surgical OncologyThe University of Texas MD Anderson Cancer Center
  • Gregory Y. Lauwers
    • Department of PathologyMassachusetts General Hospital
  • Alexis Laurent
    • Department of Digestive and Hepatobiliary Surgery and Liver TransplantationHôpital Henri Mondor
  • David M. Nagorney
    • Department of Gastroenterologic and General SurgeryMayo Clinic
  • Jacques Belghiti
    • Department of Hepato-pancreato-biliary and Transplantation SurgeryBeaujon Hospital, Assistance Publique Hôpitaux de Paris
  • Daniel Cherqui
    • Department of Digestive and Hepatobiliary Surgery and Liver TransplantationHôpital Henri Mondor
  • Ronnie Tung-Ping Poon
    • Department of Surgery, Queen Mary HospitalThe University of Hong Kong
  • Norihiro Kokudo
    • Hepato-biliary-pancreatic Surgery Division, Department of SurgeryUniversity of Tokyo
    • International Cooperative Study Group on Hepatocellular Carcinoma, Department of Surgical OncologyThe University of Texas MD Anderson Cancer Center
Hepatobiliary Tumors

DOI: 10.1245/s10434-012-2739-y

Cite this article as:
Shindoh, J., Andreou, A., Aloia, T.A. et al. Ann Surg Oncol (2013) 20: 1223. doi:10.1245/s10434-012-2739-y

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).

Copyright information

© Society of Surgical Oncology 2012