title: New Pathologic Stratification of Microvascular Invasion in Hepatocellular Carcinoma: Predicting Prognosis After Living-donor Liver Transplantation.
abstract: BACKGROUND
  Vascular invasion of hepatocellular carcinoma (HCC) has a high incidence of recurrence after liver transplantation. Patients with microvascular invasion (MVI) show a high tumor grade; however, some show a good prognosis. This retrospective study aimed to investigate whether the degree of MVI affects prognosis after living-donor liver transplantation.
  
  
  METHODS
  A total of 142 patients with HCC who had undergone living-donor liver transplantation were histologically evaluated about the number of invaded vessels and the maximum number of invading carcinoma cells. Patients with MVI were classified into two subgroups: high MVI group (n = 38), which showed more than 50 carcinoma cells in the vessels, with multiple invaded vessels; and low MVI group (n = 17), which showed MVI, but not high MVI.
  
  
  RESULTS
  Analysis of recurrence-free survival showed that high MVI group had significantly poorer outcomes than the other groups (P < 0.001). High MVI group had significantly higher α-fetoprotein levels, des-γ-carboxy prothrombin levels, number of tumors, a larger tumor size, and a higher percentage of poorly differentiated HCC than non-MVI group. High MVI was an independent prognostic factor for recurrence-free survival (P = 0.030). Among patients exceeding the Milan criteria (n = 61), high MVI group had significantly poorer outcomes than the other groups for recurrence-free survival (P = 0.003). Patients in high MVI group had significantly higher des-γ-carboxy prothrombin levels and a larger tumor size than non-MVI group. High MVI was an independent prognostic factor for recurrence-free survival (P = 0.014).
  
  
  CONCLUSIONS
  In living-donor liver transplantation for HCC, high MVI is a novel pathologic marker for predicting prognosis.
authors.affiliation: 1 Department of Surgery and Science, Kyushu University, Fukuoka, Japan. 2 Department of Anatomic Pathology, Kyushu University, Fukuoka, Japan. 3 Department of Molecular Imaging and Diagnosis, Kyushu University, Fukuoka, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Iguchi
authors.forename: Ken
authors.initials: K
authors.lastname: Shirabe
authors.forename: Shinichi
authors.initials: S
authors.lastname: Aishima
authors.forename: Huanlin
authors.initials: H
authors.lastname: Wang
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Fujita
authors.forename: Mizuki
authors.initials: M
authors.lastname: Ninomiya
authors.forename: Yo-ichi
authors.initials: Y
authors.lastname: Yamashita
authors.forename: Toru
authors.initials: T
authors.lastname: Ikegami
authors.forename: Hideaki
authors.initials: H
authors.lastname: Uchiyama
authors.forename: Tomoharu
authors.initials: T
authors.lastname: Yoshizumi
authors.forename: Yoshinao
authors.initials: Y
authors.lastname: Oda
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000098:blood supply / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D019520:Living Donors; D016015:Logistic Models; D008297:Male; D055806:Microvessels / Q000473:pathology; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000098:blood supply / Q000473:pathology; D011379:Prognosis; D011498:Protein Precursors / Q000378:metabolism; D011516:Prothrombin / Q000378:metabolism; D012189:Retrospective Studies; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: C097353:AFP protein, human; D015415:Biomarkers; D011498:Protein Precursors; D000509:alpha-Fetoproteins; C008208:acarboxyprothrombin; D011516:Prothrombin