title: Preoperative predictors of microvascular invasion in multinodular hepatocellular carcinoma.
abstract: BACKGROUND
  The preoperative predictors of microvascular invasion (MVI) in multinodular hepatocellular carcinoma (HCC) are currently unclear.
  
  
  METHODS
  We retrospectively analyzed 266 patients who underwent potentially curative resection of multinodular HCC. MVI was diagnosed on pathological examination in 64 patients. Preoperative risk factors for MVI were identified and survival curves were analyzed.
  
  
  RESULTS
  Patients with MVI had significantly lower overall and recurrence-free survival rates than those without MVI (overall survival, 1 year: 86% vs. 71%, 3 years: 58% vs. 16%; recurrence-free survival, 1 year: 69% vs. 12%; 3 years: 48% vs. 12%; both P < 0.001). Multivariate analysis showed that serum alpha-fetoprotein (AFP) level >400 μg/L (odds ratio [OR] = 3.732, P = 0.016), serum gamma-glutamyltransferase (GGT) level >130 U/L (OR = 19.779, P < 0.001), total tumor diameter >8 cm (OR = 5.545, P = 0.010), and tumor number >3 (OR = 11.566, P = 0.007) were independent predictors of MVI. A scoring system was constructed, and the MVI rate was significantly higher in patients with a score of ≥3 than those with a score of <3 (64.1% vs. 10.9%, P < 0.001). Overall and recurrence-free survival rates were significantly lower in patients with a score of ≥3 (both P < 0.001).
  
  
  CONCLUSIONS
  Serum AFP level >400 μg/L, serum GGT level >130 U/L, total tumor diameter >8 cm, and tumor number >3 were preoperative predictors of MVI in patients with multinodular HCC. In patients with a high risk of MVI and well-preserved liver function, anatomic resection may be worth considering.
authors.affiliation: Department of Hepatobiliary Surgery, PLA Navy General Hospital, No. 6 Fucheng Road, Beijing 100048, China.
authors.forename: W-C
authors.initials: WC
authors.lastname: Zhao
authors.forename: L-F
authors.initials: LF
authors.lastname: Fan
authors.forename: N
authors.initials: N
authors.lastname: Yang
authors.forename: H-B
authors.initials: HB
authors.lastname: Zhang
authors.forename: B-D
authors.initials: BD
authors.lastname: Chen
authors.forename: G-S
authors.initials: GS
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D006498:Hepatectomy / Q000379:methods / Q000401:mortality; D006801:Humans; D008099:Liver / Q000098:blood supply*; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008833:Microcirculation; D055806:Microvessels / Q000473:pathology; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: Hepatocellular carcinoma; Microvascular invasion; Multinodular