title: Infiltrative Hepatocellular Carcinoma: Assessment of Factors Associated With Outcomes in Patients Undergoing Hepatectomy.
abstract: Data on infiltrative hepatocellular carcinoma (iHCC) receiving hepatectomy are unclear. Our study assessed the outcomes, effects of anatomical resection, and prognostic factors in a cohort of Chinese patients with iHCC undergoing hepatectomy.Data from 47 patients with iHCC undergoing hepatectomy were analyzed in a retrospective study. Independent prognostic factors of overall survival (OS) and recurrence-free survival (RFS) were identified using univariate and multivariate analyses. Correlations between microvascular invasion (MVI) and clinicopathological features were assessed using the χ test, Student t test, or the Mann-Whitney U test. Survival outcomes were estimated using the Kaplan-Meier method.The median OS was 27.37 months and the 1-year RFS rate were 61.7%. Alpha-fetoprotein (AFP) level was not a specific parameter in iHCC patients undergoing hepatectomy. Anatomic resection was significantly associated with increased RFS (P = 0.007). Patients showing MVI were observed with decreased RFS (P < 0.001). A high lactate dehydrogenase (LDH) level was significantly associated with decreased OS and RFS (P = 0.003 and P = 0.020, respectively). MVI was shown correlated with the levels of aspartate aminotransferase (AST), gamma glutamyl transpeptidase (GGT), and LDH. Subgroup analysis indicated that in mild MVI group, survival outcome was significantly more favorable in patients with high LDH level (P = 0.019).iHCC patients are related with higher MVI rate and patients may still derive survival benefit from anatomic resection at early and intermediate stages. MVI classification could be used to identify iHCC patients with a poorer survival, especially those with a high preoperative LDH level.
authors.affiliation: From the Department of Hepatopancreatobiliary Surgery (XY, XF, MD, YQ), Department of Pathology (JC, JS), and Department of Radiology (JH), Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.
authors.forename: Xiaopeng
authors.initials: X
authors.lastname: Yan
authors.forename: Xu
authors.initials: X
authors.lastname: Fu
authors.forename: Min
authors.initials: M
authors.lastname: Deng
authors.forename: Jun
authors.initials: J
authors.lastname: Chen
authors.forename: Jian
authors.initials: J
authors.lastname: He
authors.forename: Jiong
authors.initials: J
authors.lastname: Shi
authors.forename: Yudong
authors.initials: Y
authors.lastname: Qiu
mesh_terms: D000328:Adult; D000368:Aged; D001219:Aspartate Aminotransferases / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D002681:China; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008297:Male; D055806:Microvessels / Q000473:pathology*; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000209:etiology / Q000401:mortality; D057234:Preoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult; D000509:alpha-Fetoproteins / Q000378:metabolism; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: D000509:alpha-Fetoproteins; D007770:L-Lactate Dehydrogenase; D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases