Hepatobiliary Tumors

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

  • Junichi ShindohAffiliated withInternational Cooperative Study Group on Hepatocellular Carcinoma, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center
  • , Andreas AndreouAffiliated withInternational Cooperative Study Group on Hepatocellular Carcinoma, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center
  • , Thomas A. AloiaAffiliated withInternational Cooperative Study Group on Hepatocellular Carcinoma, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center
  • , Giuseppe ZimmittiAffiliated withInternational Cooperative Study Group on Hepatocellular Carcinoma, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center
  • , Gregory Y. LauwersAffiliated withDepartment of Pathology, Massachusetts General Hospital
  • , Alexis LaurentAffiliated withDepartment of Digestive and Hepatobiliary Surgery and Liver Transplantation, Hôpital Henri Mondor
  • , David M. NagorneyAffiliated withDepartment of Gastroenterologic and General Surgery, Mayo Clinic
  • , Jacques BelghitiAffiliated withDepartment of Hepato-pancreato-biliary and Transplantation Surgery, Beaujon Hospital, Assistance Publique Hôpitaux de Paris
  • , Daniel CherquiAffiliated withDepartment of Digestive and Hepatobiliary Surgery and Liver Transplantation, Hôpital Henri Mondor
    • , Ronnie Tung-Ping PoonAffiliated withDepartment of Surgery, Queen Mary Hospital, The University of Hong Kong
    • , Norihiro KokudoAffiliated withHepato-biliary-pancreatic Surgery Division, Department of Surgery, University of Tokyo
    • , Jean-Nicolas VautheyAffiliated withInternational Cooperative Study Group on Hepatocellular Carcinoma, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center Email author 

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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).