Liver Resection Is Justified in Patients with BCLC Intermediate Stage Hepatocellular Carcinoma without Microvascular Invasion
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Large, multinodular (> 3 nodules and/or > 3 cm) hepatocellular carcinoma (HCC) is not an indication for liver resection based on the Barcelona Clinic Liver Cancer (BCLC) staging classification. We hypothesize that microvascular invasion (MVI) is a strong indication for surgery in these patients.
Between December 2009 and December 2010, a retrospective cohort of the patients with BCLC intermediate stage HCC undergoing surgical resection at Eastern Hepatobiliary Surgery Hospital was analyzed. Propensity score matching (PSM) was conducted to balance the patients with regard to their baseline characteristics. Survival analysis was performed according to the Kaplan–Meier method. Logistic regression was conducted to identify the predictors of MVI. Risk factors were evaluated using the Cox proportional hazards model.
Among 323 patients, the MVI-negative group (26.0%) had a more favorable prognosis than did the MVI-positive group (5-year recurrence-free survival: 25.2% vs. 7.8%; 5-year overall survival: 49.5% vs. 24.0%). Similar results were identified after PSM. Compared with MVI-negative patients, MVI-positive patients experienced more early recurrence (< 2 years, P = 0.006), multinodular recurrence (P = 0.004), and extrahepatic recurrence (P = 0.026). Total bilirubin levels > 17.1 μmol/L, alpha fetal protein levels > 400 ng/mL, the presence of > 2 nodules, and the lack of a capsule were independent predictors of MVI.
In BCLC intermediate stage HCC, MVI predicted an adverse recurrence pattern and poor prognosis and has the potential to be used as a reference index when deciding whether to operate. Factors predictive of MVI could assist in choosing preoperative treatment and postoperative surveillance.
KeywordsHepatocellular carcinoma Barcelona clinic liver cancer Intermediate stage Microvascular invasion Propensity score matching
Barcelona Clinic Liver Cancer
Propensity score matching
American Association for the Study of Liver Diseases
European Association for the Study of the Liver
Multiple nodular HCC
Eastern Cooperative Oncology Group
Alpha fetal protein
Red blood cell
We thank Hua Yu and Zhen-Ying Cao (Department of Pathology, Eastern Hepatobiliary Surgery Hospital, Shanghai) for their advice regarding the pathological techniques used in this study.
Conception: Wen-Ming Cong; study design: Wen-Ming Cong, Han Wang; administrative support: Meng-Chao Wu; data collection and acquisition: Han Wang, You-Wen Qian; data analysis: Han Wang; manuscript preparation: Han Wang, You-Wen Qian, Wen-Ming Cong; critical revision: Wen-Ming Cong; final approval of manuscript: all authors.
We received funding from the National Natural Science Foundation of China (Grant No. 81472278 and No. 8150101732), the Funds for Creative Research Groups of the National Natural Science Foundation of China (Grant No. 81521091), and the Scientific Research Foundation of the Shanghai Municipal Commission of Health and Family Planning (Grant No. 20154Y0140) for this study.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
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