title: Outcomes and predictors of microvascular invasion of solitary hepatocellular carcinoma.
abstract: OBJECTIVE
  Microvascular invasion (MVI) is an important risk factor for early recurrence of hepatocellular carcinoma (HCC), but preoperative prediction of MVI is difficult.
  
  
  METHODS
  A retrospective review was undertaken on 167 patients with primary solitary HCC who underwent initial hepatectomy. Independent predictors of MVI were identified, and factors affecting disease-free survival in patients with MVI were clarified.
  
  
  RESULTS
  Of the 167 patients, 20 patients (12%) had MVI. Recurrence rates of HCC after hepatectomy in MVI patients were significantly worse than in patients without MVI (P < 0.0361). Univariate analysis revealed that positive L3-AFP, PIVKA-II ≥ 150 mAU/mL and tumor size ≥3 cm preoperatively were associated with positive MVI. On multivariate analysis, independent predictors of MVI were PIVKA-II ≥ 150 mAU/mL (odds ratio [OR], 5.19; 95% confidence interval [95% CI], 1.44-24.87; P = 0.0109) and positive L3-AFP (OR, 3.47; 95% CI, 1.19-10.75; P = 0.0229). Among the MVI-positive group, the 1-, 2- and 3-year disease-free survival rates were 78%, 58%, and 58% in patients with surgical margin (SM) ≥ 10 mm and 38%, 29%, and 29% in those with SM < 10 mm, respectively (P = 0.0263).
  
  
  CONCLUSIONS
  Patients with PIVKA-II ≥ 150 mAU/mL and positive L3-AFP on preoperative examination are at high risk for MVI.
authors.affiliation: Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Japan.
authors.forename: Fumitoshi
authors.initials: F
authors.lastname: Hirokawa
authors.forename: Michihiro
authors.initials: M
authors.lastname: Hayashi
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Miyamoto
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Asakuma
authors.forename: Tetsunosuke
authors.initials: T
authors.lastname: Shimizu
authors.forename: Koji
authors.initials: K
authors.lastname: Komeda
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Inoue
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Uchiyama
keywords: AFP-L3; HCC; PIVKA-II; microvascular invasion