Elsevier

Surgery

Volume 127, Issue 6, June 2000, Pages 603-608
Surgery

Original Communications
Clinical significance of microscopic tumor venous invasion in patients with resectable hepatocellular carcinoma*,**

https://doi.org/10.1067/msy.2000.105498Get rights and content

Abstract

Background: Tumor venous invasion in patients with resectable hepatocellular carcinoma (HCC) is frequent and can be macroscopic and microscopic or microscopic alone. Although macroscopic invasion is a well-established prognostic indicator, the clinical significance of microscopic invasion remains unclear. Methods: There were 322 patients enrolled who had undergone curative resection for HCC. The clinicopathologic factors and prognostic significance associated with macroscopic and microscopic venous invasion were analyzed. Results: Macroscopic invasion was observed in 50 patients (15.5%) and microscopic invasion in 190 (59.0%). The larger the tumor, the more the incidence of venous invasion. There were 140 patients with microscopic invasion only (Group 1). Patients with macroscopic invasion (Group 2, n = 50) also had microscopic invasion. Compared with patients without venous invasion (Group 3, n = 132), Group 1 had a higher α-fetoprotein level, a larger tumor size, and more tumors without encapsulation. For group 1, the 1-, 3-, and 5-year disease-free survival rates were 65.6%, 41.6%, and 30.8%, respectively. The 1-, 3-, and 5-year overall survival rates were 87.8%, 60.0%, and 52.7%, respectively. The survival rates of group 1 were lower than those of group 3 and higher than those of group 2 (P <.05). Multivariate analysis indicated that microscopic and macroscopic venous invasion, surgical margin, indocyanine-green retention, and tumor size and number were significant predictors of postresectional survival. Conclusions: In HCC patients, microscopic venous invasion is frequent and related independently to postresectional outcome. (Surgery 2000;127:603-8.)

Section snippets

Patients and methods

Between July 1991 and December 1997, there were 322 patients enrolled who had HCC and who had undergone hepatectomy at Veterans General Hospital-Taipei. These patients had the tumor tissue completely removed macroscopically. Twelve patients had a microscopic positive surgical margin on subsequent histologic examination.

There were 281 men and 41 women of mean age 60 (range, 20 to 89 years)(Table I).There were 41 patients who had received preoperative trans-catheter arterial chemoembolization,

Results

Macroscopic venous invasion was observed in 50 of the 322 patients (15.5%), and microscopic invasion was observed in 190 (59.0%). The relationship between tumor size and the percentages of macroscopic and microscopic tumor invasion is shown in Fig 1.

. Frequency of microscopic and macroscopic venous involvement in 322 patients with HCC stratified according to the tumor size.

For 37 patients with tumor size ≤2cm, one (2.7%) had macroscopic, and 15 (40.5%) had microscopic invasion. As a whole,

Discussion

In this study we found that 59.0% of the patients with HCC had either macroscopic and microscopic tumor venous invasion or microscopic tumor venous invasion alone. The larger the size of the tumor, the higher the incidence of venous invasion. Multivariate analysis showed that both macroscopic and microscopic venous invasion correlated significantly with postresectional survivals. These findings indicated that microscopic venous invasion has an important role in the HCC disease process.

In

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    *

    Supported in part by a grant from The Common Good to Surgeons Foundation (CGSF-87-24), Taipei, Taiwan, Republic of China.

    **

    Reprint requests: Gar-Yang Chau, MD, MPH, Division of General Surgery, Department of Surgery, Veterans General Hospital-Taipei, Shih-pai, Taipei, Taiwan, 217

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