Predictors of microvascular invasion in patients with hepatocellular carcinoma who are candidates for orthotopic liver transplantation.
Microvascular invasion affects survival after orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC). We sought to identify preoperative predictors of microvascular invasion in patients with HCC who were candidates for OLT. A cohort of 245 patients who underwent resection for HCC and fulfilled the criteria for OLT (i.e., single tumors < or =5 cm or no more than three tumors < or =3 cm) were identified from a multi-institutional database. Thirty-three percent of the patients had pathologic evidence of microvascular invasion. Thirty percent of patients with single tumors and 47% with multiple tumors had microvascular invasion (P = 0.04). Only 25% of patients with tumors smaller than < or =2 cm had microvascular invasion, compared to 31% and 50% with tumors greater than 2 to 4 cm or larger than 4 cm, respectively (P = 0.01). Tumor grade was highly correlated with microvascular invasion: 12% of patients with well-differentiated tumors had microvascular invasion, compared to 29% and 50% with moderately or poorly differentiated tumors, respectively (P < 0.001). The independent predictors of microvascular invasion were tumor size greater than 4 cm (odds ratio [OR], 3.0, 95% confidence interval [CI ], 1.2 to 7.1), and high tumor grade (OR, 6.3; 95% CI, 2.0 to 19.9). Tumor size and grade are strong predictors of microvascular invasion. A tumor biopsy with pathologic grading at the time of pretransplantation ablative therapy could improve selection of patients with HCC for OLT.
Esnaola
Nestor F
NF
Department of Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030-4009, USA.
Lauwers
Gregory Y
GY
Mirza
Nadeem Q
NQ
Nagorney
David M
DM
Doherty
Dorota
D
Ikai
Iwao
I
Yamaoka
Yoshio
Y
Regimbeau
Jean Marc
JM
Belghiti
Jacques
J
Curley
Steven A
SA
Ellis
Lee M
LM
Vauthey
J Nicolas
JN
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D006502:Budd-Chiari Syndrome / Q000473:pathology; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D016009:Chi-Square Distribution; D015331:Cohort Studies; D005260:Female; D006085:Graft Survival; D006801:Humans; D008113:Liver Neoplasms / Q000098:blood supply / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000517:prevention & control; D009367:Neoplasm Staging; D011169:Portal Vein / Q000473:pathology; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011336:Probability; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome