title: Microvascular invasion does not predict long-term survival in hepatocellular carcinoma up to 2 cm: reappraisal of the staging system for solitary tumors.
abstract: BACKGROUND
  Excellent long-term outcomes have been reported recently for patients with small (≤2 cm) hepatocellular carcinoma (HCC). However, the significance of microvascular invasion (MVI) in small HCC remains unclear. The purpose of this study was to determine the impact of MVI in small HCC up to 2 cm.
  
  
  METHODS
  In 1,109 patients with solitary HCC from six major international hepatobiliary centers, the impact of MVI on long-term survival in patients with small HCC (≤2 cm) and patients with tumors larger than 2 cm was analyzed.
  
  
  RESULTS
  In patients with small HCC, long-term survival was not affected by MVI (p = 0.8), whereas in patients with larger HCC, significantly worse survival was observed in patients with MVI (p < 0.0001). In multivariate analysis, MVI (hazard ratio [HR] 1.59; 95 % confidence interval (CI) 1.27-1.99; p < 0.001), elevated alpha-fetoprotein (HR 1.41; 95 % CI 1.11-1.8; p = 0.005), and higher histologic grade (HR 1.29; 95 % CI 1.01-1.64; p = 0.04) were significant predictors of worse survival in patients with HCC larger than 2 cm but were not correlated with long-term survival in small HCC. When the cohort was divided into three groups-HCC ≤2, >2 cm without MVI, and HCC >2 cm with MVI-significant between-group survival difference was observed (p < 0.0001).
  
  
  CONCLUSIONS
  Small HCC is associated with an excellent prognosis that is not affected by the presence of MVI. The discriminatory power of the 7th edition of the AJCC classification for solitary HCC could be further improved by subdividing tumors according to size (≤2 vs. >2 cm).
authors.affiliation: International Cooperative Study Group on Hepatocellular Carcinoma, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Junichi
authors.initials: J
authors.lastname: Shindoh
authors.forename: Andreas
authors.initials: A
authors.lastname: Andreou
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Aloia
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Zimmitti
authors.forename: Gregory Y
authors.initials: GY
authors.lastname: Lauwers
authors.forename: Alexis
authors.initials: A
authors.lastname: Laurent
authors.forename: David M
authors.initials: DM
authors.lastname: Nagorney
authors.forename: Jacques
authors.initials: J
authors.lastname: Belghiti
authors.forename: Daniel
authors.initials: D
authors.lastname: Cherqui
authors.forename: Ronnie Tung-Ping
authors.initials: RT
authors.lastname: Poon
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kokudo
authors.forename: Jean-Nicolas
authors.initials: JN
authors.lastname: Vauthey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000235:genetics*; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000401:mortality* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D004279:DNA, Viral / Q000235:genetics; D005260:Female; D005500:Follow-Up Studies; D016174:Hepacivirus / Q000472:pathogenicity; D006509:Hepatitis B / Q000150:complications / Q000473:pathology / Q000821:virology; D006515:Hepatitis B virus / Q000472:pathogenicity; D006526:Hepatitis C / Q000150:complications / Q000473:pathology / Q000821:virology; D006801:Humans; D008113:Liver Neoplasms / Q000209:etiology / Q000401:mortality* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D009367:Neoplasm Staging / Q000592:standards*; D011184:Postoperative Period; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D055815:Young Adult; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D014408:Biomarkers, Tumor; D004279:DNA, Viral; D000509:alpha-Fetoproteins