Long-term outcomes after curative resection for patients with macroscopically solitary hepatocellular carcinoma without macrovascular invasion and an analysis of prognostic factors

Abstract

The long-term outcome and prognostic factors after curative in patients with single hepatocellular carcinoma (HCC) without macrovascular invasion are still unclear. The objective of this study is to evaluate the effect of curative resection on survival and analyze the prognostic clinicopathologic factors, especially the presence of microvascular invasion (MVI), in these patients. Two hundred and sixty consecutive patients with single HCC without macrovascular invasion who underwent curative resection from December 2004 to December 2007 were retrospectively reviewed in this study. Survival rates were calculated by using the Kaplan-Meier method. Univariate and multivariate analyses of 14 clinicopathologic factors were performed to determine the significant prognostic factors. No patient died within 1 month after the operation. The 1-, 3-, and 5-year overall survival rates after curative resection were 96.54, 83.46, and 74.01%, respectively. Multivariate analysis revealed that only the presence of MVI was an independent negative prognostic factor affecting overall survival. The 1-, 3-, and 5-year disease-free survival rates were 79.62, 62.69, and 56.01%, respectively. The presence of MVI was the only independent unfavorable prognostic factor for disease-free survival. According to our analysis, patients with single HCC without macrovascular invasion after curative resection can be expected to have considerable long-term survival. The presence of MVI was an independent negative prognostic factor for both overall survival and disease-free survival. To improve the prognosis, these patients should be followed up more carefully and might be good candidates for adjuvant therapy.

Adjuvant transcatheter arterial chemoembolization after curative resection for hepatocellular carcinoma patients with solitary tumor and microvascular invasion: a randomized clinical trial of efficacy and safety

“…Recent studies have confirmed the significance of MVI in postoperative recurrence [ 11 – 13 ]. A previous study by our research group also showed that the recurrence rate was over 50% for HCC patients with solitary tumor ≥ 5 cm and MVI, where MVI was confirmed as the only independent risk factor for overall survival (OS) and disease-free survival (DFS) among that cohort [ 14 ].…”

Stereotactic body radiotherapy based treatment for hepatocellular carcinoma with extensive portal vein tumor thrombosis

“…Although the survival rate of patients with HCC has been improved recently, the prognosis for those with PVTT remains poor, as their median survival is only 2–4 months via supportive care [ 8 ]. Overall, PVTT plays a major role in predicting the therapeutic outcome and clinical staging of HCC [ 9 , 10 ].…”

Surgical resection for hepatocellular carcinoma with portal vein tumor thrombus in the Asia-Pacific region beyond the Barcelona Clinic Liver Cancer treatment algorithms: a review and update

“…Portal vein vascular invasion to residual tumors and promote intrahepatic metastasis, which has been well defined and accepted as a major mechanism contributing to early recurrence (2 years after resection), leading to poor postoperative survival [ 5 – 9 ]. Recent findings indicate that microvascular invasion is another independent risk factor for early recurrence in single HCC without macrovascular invasion [ 69 – 72 ]. Moreover, compression and crushing of tissue during the operative process might create new intrahepatic metastases.…”

“…Owing to the biological characteristics of HCC and the anatomical characteristics of the liver, HCC is prone to invade intrahepatic vessels, especially the portal venous system. Portal vein tumor thrombus (PVTT) was detected in about 10–60% of patients with HCC at the time of diagnosis, [ 2 ] and has been proved to play an important role in prognosis and clinical staging of HCC [ 3 – 4 ]. Once the PVTT has developed rapidly and progressed into the contralateral bifurcation or the main trunk of portal vein, obstruction by the tumor thrombus usually promotes disease progression, aggravates portal vein hypertension and its related complications, deteriorates liver function reserve, and induces tolerance to anti-tumor treatment.…”