Annals of Surgical Oncology

, Volume 26, Issue 12, pp 4117–4125 | Cite as

Association of Preoperative Hypercoagulability with Poor Prognosis in Hepatocellular Carcinoma Patients with Microvascular Invasion After Liver Resection: A Multicenter Study

  • Xiu-Ping Zhang
  • Teng-Fei Zhou
  • Zhi-Heng Wang
  • Fan Zhang
  • Cheng-Qian Zhong
  • Yi-Ren Hu
  • Kang Wang
  • Zong-Tao Chai
  • Zhen-Hua Chen
  • Meng-Chao Wu
  • Wan Yee Lau
  • Shu-Qun ChengEmail author
Hepatobiliary Tumors



Microvascular invasion (MVI) predicts poor prognosis in patients with hepatocellular carcinoma (HCC). HCC patients with hypercoagulability are prone to develop thrombosis; however, the relationship between preoperative coagulability state, as reflected by the international normalized ratio (INR) level, and MVI remains unclear.


From January 2009 to December 2012, HCC patients who underwent R0 liver resection (LR) from four cancer centers entered into this study. The overall survival (OS) and recurrence-free survival (RFS) rates were compared using the Kaplan–Meier method and Cox regression analysis.


Of the 2509 HCC patients who were included into this study, 1104 were found to have MVI in the resected specimens. These patients were divided into the low (n = 151), normal (n = 796), and high (n = 157) INR subgroups based on the preoperative INR levels. The low INR subgroup had a significantly higher incidence of MVI than the normal or high INR subgroups (61.6% vs. 41.6% vs. 44.6%; p < 0.001). HCC patients with MVI were significantly more likely to have a low preoperative INR level (p < 0.001); the INR level (p < 0.001) was an independent risk factor of OS and RFS. HCC patients with MVI in the low INR subgroup had significantly worse RFS and OS than the normal or high INR subgroups (median RFS 13.5 vs. 20.2 vs. 21.6 months, p < 0.001; median OS 35.5 vs. 59.5 vs. 57.0 months, p < 0.001).


Preoperative hypercoagulability was associated with poor long-term prognosis in HCC patients with MVI after R0 LR.


Author contributions

S-QC, WYL, X-PZ, M-CW: Conception and design. S-QC: Financial support. FZ, C-QZ, Y-RH, KW, Z-TC, Z-HC: Provision of study materials or patients. X-PZ, Z-HW: Collection and assembly of data. X-PZ, T-FZ: Data analysis and interpretation. X-PZ, WYL: Manuscript writing. All authors: Final approval of manuscript.


This study was supported by the Key Project of Natural Science Foundation of China (No. 81730097); grants from the Science Fund for Creative Research Groups (No. 81521091); the National Key Basic Research Program ‘973 project’ (No. 2015CB554000); and the National Natural Science Foundation of China (Nos. 81602523, 81702335).


No potential conflict of interest were disclosed.

Supplementary material

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Supplementary material 1 (DOC 86 kb)
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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Xiu-Ping Zhang
    • 1
  • Teng-Fei Zhou
    • 2
  • Zhi-Heng Wang
    • 3
  • Fan Zhang
    • 4
  • Cheng-Qian Zhong
    • 5
  • Yi-Ren Hu
    • 6
  • Kang Wang
    • 1
  • Zong-Tao Chai
    • 1
  • Zhen-Hua Chen
    • 1
  • Meng-Chao Wu
    • 1
  • Wan Yee Lau
    • 1
    • 7
  • Shu-Qun Cheng
    • 1
    Email author
  1. 1.Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery HospitalSecond Military Medical UniversityShanghaiChina
  2. 2.The No. 313 Hospital of PLAHuludaoChina
  3. 3.Department of Hepatic Surgery III, Eastern Hepatobiliary Surgery HospitalSecond Military Medical UniversityShanghaiChina
  4. 4.Department of Hepatobiliary SurgeryAffiliated Hospital of Binzhou Medical CollegeYantai CityChina
  5. 5.LongYan First HospitalAffiliated to Fujian Medical UniversityFuzhouChina
  6. 6.Department of General SurgeryWenzhou People’s HospitalWenzhouChina
  7. 7.Faculty of MedicineThe Chinese University of Hong KongShatinChina

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