Clinicopathological Characteristics of Hepatocellular Carcinoma with Microscopic Portal Venous Invasion and the Role of Anatomical Liver Resection in These Cases
Corresponding Author
Shingo Shimada
- [email protected]
- +81-11-7065927
Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North15-West7, Kita-Ku, 060-8638 Sapporo, Hokkaido, Japan
Tel.: +81-11-7065927, [email protected]Search for more papers by this authorToshiya Kamiyama
Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North15-West7, Kita-Ku, 060-8638 Sapporo, Hokkaido, Japan
Search for more papers by this authorHideki Yokoo
Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North15-West7, Kita-Ku, 060-8638 Sapporo, Hokkaido, Japan
Search for more papers by this authorTatsuya Orimo
Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North15-West7, Kita-Ku, 060-8638 Sapporo, Hokkaido, Japan
Search for more papers by this authorKenji Wakayama
Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North15-West7, Kita-Ku, 060-8638 Sapporo, Hokkaido, Japan
Search for more papers by this authorTakahiro Einama
Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North15-West7, Kita-Ku, 060-8638 Sapporo, Hokkaido, Japan
Search for more papers by this authorTatsuhiko Kakisaka
Department of Surgery, Sapporo Kousei Hospital, Sapporo, Japan
Search for more papers by this authorHirofumi Kamachi
Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North15-West7, Kita-Ku, 060-8638 Sapporo, Hokkaido, Japan
Search for more papers by this authorAkinobu Taketomi
Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North15-West7, Kita-Ku, 060-8638 Sapporo, Hokkaido, Japan
Search for more papers by this authorCorresponding Author
Shingo Shimada
- [email protected]
- +81-11-7065927
Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North15-West7, Kita-Ku, 060-8638 Sapporo, Hokkaido, Japan
Tel.: +81-11-7065927, [email protected]Search for more papers by this authorToshiya Kamiyama
Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North15-West7, Kita-Ku, 060-8638 Sapporo, Hokkaido, Japan
Search for more papers by this authorHideki Yokoo
Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North15-West7, Kita-Ku, 060-8638 Sapporo, Hokkaido, Japan
Search for more papers by this authorTatsuya Orimo
Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North15-West7, Kita-Ku, 060-8638 Sapporo, Hokkaido, Japan
Search for more papers by this authorKenji Wakayama
Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North15-West7, Kita-Ku, 060-8638 Sapporo, Hokkaido, Japan
Search for more papers by this authorTakahiro Einama
Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North15-West7, Kita-Ku, 060-8638 Sapporo, Hokkaido, Japan
Search for more papers by this authorTatsuhiko Kakisaka
Department of Surgery, Sapporo Kousei Hospital, Sapporo, Japan
Search for more papers by this authorHirofumi Kamachi
Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North15-West7, Kita-Ku, 060-8638 Sapporo, Hokkaido, Japan
Search for more papers by this authorAkinobu Taketomi
Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North15-West7, Kita-Ku, 060-8638 Sapporo, Hokkaido, Japan
Search for more papers by this authorAbstract
Background
The aims of this study were to investigate predictive factors for microscopic portal venous invasion (mPVI) in hepatocellular carcinoma (HCC) and whether anatomical liver resection (ALR) was useful in such cases.
Methods
We analyzed 852 patients with HCC without macroscopic portal venous invasion who were treated at our hospital between January 1990 and May 2014. These patients were stratified into a microscopic portal venous invasion group (mPVI group; n = 153) and non-microscopic portal venous invasion group (NmPVI group; n = 699).
Results
PIVKA-II ≥100 mAU/ml, a tumor size ≥5 cm, a confluent lesion, and poor differentiation were found to be independent risk factors for mPVI. Among the mPVI group who had single HCC under 5 cm, serum albumin level <4.0 g/dl, PIVKA-II ≥100 mAU/ml, a positive surgical margin, and non-ALR (NALR) were independent unfavorable prognostic factors for overall survival (OS). PIVKA-II ≥100 mAU/ml, a positive surgical margin and NALR were independent unfavorable prognostic factors for relapse-free survival (RFS). ALR was significantly favorable factor for both OS and RFS of the mPVI group who had single HCC under 5 cm.
Conclusions
Even if no portal venous invasion is detectable in HCC patients preoperatively, a PIVKA-II ≥100 mAU/ml, tumor size ≥5 cm, and a confluent lesion indicate a high risk of mPVI. ALR should be considered for the patients with these characteristics because it is a favorable prognostic factor in these cases with mPVI.
References
- 1AhmedF, PerzJF, KwongS et al. National trends and disparities in the incidence of hepatocellular carcinoma 1998–2003. Prev Chronic Dis (2008) 5(3): A7418558024
- 2AriiS, TanakaJ, YamazoeY et al. Predictive factors for intrahepatic recurrence of hepatocellular carcinoma after partial hepatectomy. Cancer (1992) 69(4): 913–91910.1002/1097-0142(19920215)69:4<913::AID-CNCR2820690413>3.0.CO;2-T1310434
10.1002/1097-0142(19920215)69:4<913::AID-CNCR2820690413>3.0.CO;2-T CAS PubMed Web of Science® Google Scholar
- 3IkaiI, AriiS, KojiroM et al. Reevaluation of prognostic factors for survival after liver resection in patients with hepatocellular carcinoma in a Japanese nationwide survey. Canser (2004) 101(4): 796–802
10.1002/cncr.20426 Google Scholar
- 4NelsonRC, ChezmarJL, SugarbakerPH et al. Preoperative localization of focal liver lesions to specific liver segments: utility of CT during arterial portography. Radiology (1990) 176(1): 89–9410.1148/radiology.176.1.23531152353115
- 5BachAM, HannLE, BrownKT et al. Portal vein evaluation with US: comparison to angiography combined with CT arterial portography. Radiology (1996) 201(1): 149–15410.1148/radiology.201.1.88165368816536
- 6HannLE, SchwartzLH, PanicekDM et al. Tumor involvement in hepatic veins: comparison of MR imaging and US for preoperative assessment. Radiology (1998) 206(3): 651–65610.1148/radiology.206.3.94944829494482
- 7TsaiTJ, ChauGY, LuiWY et al. Clinical significance of microscopic tumor venous invasion in patients with resectable hepatocellular carcinoma. Surgery (2000) 127(6): 603–60810.1067/msy.2000.10549810840353
- 8ShirabeK, KajiyamaK, HarimotoN et al. Prognosis of hepatocellular carcinoma accompanied by microscopic portal vein invasion. World J Gastroenterol (2009) 15(21): 2632–263710.3748/wjg.15.263219496194
- 9EguchiS, TakatsukiM, HidakaM et al. Predictor for histological microvascular invasion of hepatocellular carcinoma: a lesson from 229 consecutive cases of curative liver resection. World J Surg (2010) 34(5): 1034–103810.1007/s00268-010-0424-520127241
- 10FujitaN, AishimaS, IguchiT et al. Histologic classification of microscopic portal venous invasion to predict prognosis in hepatocellular carcinoma. Hum Pathol (2011) 42(10): 1531–153810.1016/j.humpath.2010.12.01621496875
- 11FuksD, DokmakS, ParadisV et al. Benefit of initial resection of hepatocellular carcinoma followed by transplantation in case of recurrence: an intention-to-treat analysis. Hepatology (2012) 55(1): 132–14010.1002/hep.2468021932387
- 12NanashimaA, TobinagaS, KunizakiM et al. Strategy of treatment for hepatocellular carcinomas with vascular infiltration in patients undergoing hepatectomy. J Surg Oncol (2010) 101(7): 557–56310.1002/jso.2153420213729
- 13ClavienPA, BarkunJ, de OliveiraML et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg (2009) 250(2): 187–19610.1097/SLA.0b013e3181b13ca219638912
- 14KamiyamaT, NakanishiK, YokooH et al. Perioperative management of hepatic resection toward zero mortality and morbidity: analysis of 793 consecutive cases in a single institution. J Am Coll Surg (2010) 211(4): 443–44910.1016/j.jamcollsurg.2010.06.00520822741
- 15KimSU, JungKS, LeeS et al. Histological subclassification of cirrhosis can predict recurrence after curative resection of hepatocellular carcinoma. Liver Int (2014) 34(7): 1008–101710.1111/liv.1247524483989
- 16MitsunobuM, ToyosakaA, OriyamaT et al. Intrahepatic metastases in hepatocellular carcinoma: the role of the portal vein as an efferent vessel. Clin Exp Metastasis (1996) 14(6): 520–52910.1007/BF001151128970582
- 17ShirabeK, ItohS, YoshizumiT et al. The predictors of microvascular invasion in candidates for liver transplantation with hepatocellular carcinoma: with special reference to the serum levels of des-gamma-carboxy prothrombin. J Surg Oncol (2007) 95(3): 235–24010.1002/jso.2065517323337
- 18ShirabeK, KajiyamaK, AbeT et al. Predictors of microscopic portal vein invasion by hepatocellular carcinoma: measurement of portal perfusion defect area ratio. J Gastroenterol Hepatol (2009) 24(8): 1431–143610.1111/j.1440-1746.2009.05847.x19486447
- 19AdachiE, MaedaT, KajiyamaK et al. Factors correlated with portal venous invasion by hepatocellular carcinoma. Cancer (1996) 77(10): 2022–203110.1002/(SICI)1097-0142(19960515)77:10<2022::AID-CNCR9>3.0.CO;2-S8640665
10.1002/(SICI)1097-0142(19960515)77:10<2022::AID-CNCR9>3.0.CO;2-S CAS PubMed Web of Science® Google Scholar
- 20KenmochiK, SugiharaS, KojiroM Relationship of histologic grade of hepatocellular carcinoma (HCC) to tumor size, and demonstration of tumor cells of multiple different grade in single small HCC. Liver (1987) 7(1): 18–2610.1111/j.1600-0676.1987.tb00310.x3033422
- 21HuZ, ZhouJ, WangH et al. Survival in liver transplant recipients with hepatitis B- or hepatitis C-associated hepatocellular carcinoma: the chinese experience from 1999 to 2010. PLoS ONE (2013) 8(4): e6162010.1371/journal.pone.006162023613886
- 22HiotisSP, RahbariNN, VillanuevaGA et al. Hepatitis B vs. hepatitis C infection on viral hepatitis-associated hepatocellular carcinoma. BMC Gastroenterol (2012) 12: 6410.1186/1471-230X-12-6422681852
- 23BelghitiJ, PanisY, FargesO et al. Intrahepatic recurrence after resection of hepatocellular carcinoma complicating cirrhosis. Ann Surg (1991) 214(2): 114–11710.1097/00000658-199108000-000041714267
- 24FanST, NgIO, PoonRT et al. Hepatectomy for hepatocellular carcinoma: the surgeon’s role in long-term survival. Arch Surg (1999) 134(10): 1124–113010.1001/archsurg.134.10.112410522859
- 25LauH, FanST, NgIO et al. Long term prognosis after hepatectomy for hepatocellular carcinoma: a survival analysis of 204 consecutive patients. Cancer (1998) 83(11): 2302–231110.1002/(SICI)1097-0142(19981201)83:11<2302::AID-CNCR9>3.0.CO;2-19840529
10.1002/(SICI)1097-0142(19981201)83:11<2302::AID-CNCR9>3.0.CO;2-1 CAS PubMed Web of Science® Google Scholar
- 26MatsumataT, KanematsuT, TakenakaK et al. Patterns of intrahepatic recurrence after curative resection of hepatocellular carcinoma. Hepatology (1989) 9(3): 457–46010.1002/hep.18400903202537789
- 27JwoSC, ChiuJH, ChauGY et al. Risk factors linked to tumor recurrence of human hepatocellular carcinoma after hepatic resection. Hepatology (1992) 16(6): 1367–137110.1002/hep.18401606111332922
- 28YamamotoJ, KosugeT, TakayamaT et al. Recurrence of hepatocellular carcinoma after surgery. Br J Surg (1996) 83(9): 1219–122210.1002/bjs.18008309138983610
- 29NagaoT, InoueS, YoshimiF et al. Postoperative recurrence of hepatocellular carcinoma. Ann Surg (1990) 211(1): 28–3310.1097/00000658-199001000-000051688488
- 30PoonRT, FanST, NgIO et al. Different risk factors and prognosis for early and late intrahepatic recurrence after resection of hepatocellular carcinoma. Hepatology (2000) 89(3): 500–507
- 31HasegawaK, KokudoN, ImamuraH et al. Prognostic impact of anatomic resection for hepatocellular carcinoma. Ann Surg (2005) 242(2): 252–25910.1097/01.sla.0000171307.37401.db16041216
- 32OkamuraY, ItoT, SugiuraT et al. Anatomic versus nonanatomic hepatectomy for a solitary hepatocellular carcinoma. J Gastrointest Surg (2014) 18(11): 1994–200210.1007/s11605-014-2646-625213582
- 33MarubashiS, GotohK, AkitaH et al. Anatomical versus non-anatomical resection for hepatocellular carcinoma. Br J Surg (2015) 102(7): 776–78410.1002/bjs.981525847111
- 34KobayashiA, MiyagawaS, MiwaS et al. Prognostic impact of anatomical resection on early and late intrahepatic recurrence in patients with hepatocellular carcinoma. J Hepatobiliary Pancreat Surg (2008) 15(5): 515–52110.1007/s00534-007-1293-718836806
- 35MatsumotoT, KubotaK, AokiT et al. Clinical impact of anatomical liver resection for hepatocellular carcinoma with pathologically proven portal vein invasion. World J Surg (2016) 40(2): 402–41110.1007/s00268-015-3231-126306893
- 36YamashitaY, ImaiD, BekkiY et al. Surgical outcomes of anatomical resection for solitary recurrent hepatocellular carcinoma. Anticancer Res (2014) 34(8): 4421–442625075080
