Journal
SURGERY
Volume 127, Issue 6, Pages 603-608Publisher
MOSBY-YEAR BOOK INC
DOI: 10.1067/msy.2000.105498
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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 clinico-pathologic 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 (53.0%). The larger the tumor; the more the incidence of venous invasion. There were 140 patients with microscopic invasion only (Croup I). Patients with macroscopic invasion (Group 2, n = 50) also had microscopic invasion. Compared with patients without venous invasion (Croup 3, n = 132), Group 1 had a higher alpha-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 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 anti number were significant predictors of postresectional survival. Conclusions. In HCC patients, microscopic venous invasion is frequent and related independently to postresectional outcome.
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