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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

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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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Acknowledgment

The authors thank Ms. Stephanie Deming and Ms. Ruth Haynes for their contribution to our manuscript. The University of Texas MD Anderson Cancer Center is supported in part by the National Institutes of Health through Cancer Center Support Grant CA016672.

Disclosures

Authors have no conflict of interest to disclose.

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Authors and Affiliations

  1. International Cooperative Study Group on Hepatocellular Carcinoma, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Junichi Shindoh MD, PhD, Andreas Andreou MD, Thomas A. Aloia MD, Giuseppe Zimmitti MD & Jean-Nicolas Vauthey MD

  2. Department of Pathology, Massachusetts General Hospital, Boston, MA, USA

    Gregory Y. Lauwers MD

  3. Department of Digestive and Hepatobiliary Surgery and Liver Transplantation, Hôpital Henri Mondor, Créteil, France

    Alexis Laurent MD & Daniel Cherqui MD

  4. Department of Gastroenterologic and General Surgery, Mayo Clinic, Rochester, MI, USA

    David M. Nagorney MD

  5. Department of Hepato-pancreato-biliary and Transplantation Surgery, Beaujon Hospital, Assistance Publique Hôpitaux de Paris, Clichy, France

    Jacques Belghiti MD

  6. Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China

    Ronnie Tung-Ping Poon MS, FRCS

  7. Hepato-biliary-pancreatic Surgery Division, Department of Surgery, University of Tokyo, Tokyo, Japan

    Norihiro Kokudo MD, PhD

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  1. Junichi Shindoh MD, PhD
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  2. Andreas Andreou MD
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Correspondence to Jean-Nicolas Vauthey MD.

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Shindoh, J., Andreou, A., Aloia, T.A. et al. Microvascular Invasion Does Not Predict Long-Term Survival in Hepatocellular Carcinoma up to 2 cm: Reappraisal of the Staging System for Solitary Tumors. Ann Surg Oncol 20, 1223–1229 (2013). https://doi.org/10.1245/s10434-012-2739-y

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