title: Second Hepatectomy Improves Survival in Patients With Microvascular Invasive Hepatocellular Carcinoma Meeting the Milan Criteria.
abstract: Microvascular invasion (MVI) is a strong risk factor for patients with hepatocellular carcinoma (HCC) meeting the Milan criteria and who have received curative hepatectomy. The relevance of a second hepatectomy in patients with MVI-positive recurrent HCC remains controversial. We had 329 cases of HCC hepatectomy meeting the Milan criteria and compared data on patient demographics, liver function, and tumor pathology between MVI-positive and MVI-negative group. We analyzed potential risk factors of overall survival (OS) and disease-free survival (DFS). Furthermore, newly developed pathological features following the second hepatectomy were also analyzed.The median OS and DFS were significantly superior in the MVI-negative group than in the MVI-positive group, 61 (10-81) versus 49 (11-82) months (P < 0.01) and 41 (7-75) versus 13 (3-69) months (P <  0.01), respectively. The presence of MVI and a total tumor diameter >3 cm were independent risk factors associated with both OS and DFS. Overall survival was significantly improved by a second hepatectomy in the MVI-positive group compared with the original MVI-positive group, 60 (26-82) versus 49 (11-82) months, respectively. This was now comparable to the MVI-negative group, 60 (26-82) versus 61 (10-81) months (P = 0.72). A second hepatectomy was consistently associated with better survival in the MVI-negative group as compared to the MVI-positive group. A second hepatectomy improves survival in patients with MVI HCC meeting the Milan criteria. The biology of MVI may change following a second hepatectomy. The absence of MVI is a good prognostic sign for patients undergoing second hepatectomy.
authors.affiliation: From the Department of Hepatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
authors.forename: Yi-Fu
authors.initials: YF
authors.lastname: Hou
authors.forename: Bo
authors.initials: B
authors.lastname: Li
authors.forename: Yong-Gang
authors.initials: YG
authors.lastname: Wei
authors.forename: Jia-Yin
authors.initials: JY
authors.lastname: Yang
authors.forename: Tian-Fu
authors.initials: TF
authors.lastname: Wen
authors.forename: Ming-Qing
authors.initials: MQ
authors.lastname: Xu
authors.forename: L V-Nan
authors.initials: LV
authors.lastname: Yan
authors.forename: Ke-Fei
authors.initials: KF
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006305:Health Status Indicators; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors