Strategy of treatment for hepatocellular carcinomas with vascular infiltration in patients undergoing hepatectomy.
OBJECTIVE
Vascular infiltration (VI) is an important prognostic factor for hepatocellular carcinoma (HCC) and predictive parameters are necessary to preoperatively decide treatment strategies in patients with HCC.


METHODS
Relationships between presence and degree of VI in the portal and hepatic veins and bile duct, and post-hepatectomy survival were examined in 271 HCC patients who underwent hepatectomy.


RESULTS
VI was observed in 81 patients (30%). Disease-free and overall survival rates was significantly lower in patients with VI than in patients without VI, and became poorer according to the degree of infiltration (P < 0.01). Multiple, increased size, non-meeting of Milan criteria, irregular macroscopic findings and increased PIVKA-II levels were associated with degree of VI in portal vein (P < 0.01). Increased size and increased PIVKA-II level were associated with degree of VI in hepatic vein (P < 0.05). Non-meeting of Milan criteria was associated with degree of infiltration in bile duct (P = 0.034). Survival was significantly better following anatomical resection than with non-anatomical resection and, furthermore, survival was better with surgical margins >5 mm than with shorter margins in patients who underwent non-anatomical resection.


CONCLUSIONS
Adequate extent of operative procedures, but not limited resection with short margins, is useful when predictive parameters associated with VI are observed.
Nanashima
Atsushi
A
Division of Surgical Oncology, Hepatology, Nagasaki University Hospital, Nagasaki, Japan. a-nanasm@alpha.med.nagasaki-u.ac.jp
Tobinaga
Syuuichi
S
Kunizaki
Masaki
M
Miuma
Satoshi
S
Taura
Naota
N
Takeshita
Hiroaki
H
Hidaka
Shigekazu
S
Sawai
Terumitsu
T
Nakao
Kazuhiko
K
Nagayasu
Takeshi
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001652:Bile Ducts / Q000378:metabolism; D015415:Biomarkers / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006503:Hepatic Veins / Q000378:metabolism; D006801:Humans; D007564:Japan; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating; D018579:Patient Selection; D011169:Portal Vein / Q000378:metabolism; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood; D011516:Prothrombin; D016019:Survival Analysis
D015415:Biomarkers; D011498:Protein Precursors; C008208:acarboxyprothrombin; D011516:Prothrombin