title: A pre-operative clinical model to predict microvascular invasion and long-term outcome after resection of hepatocellular cancer: The Australian experience.
abstract: BACKGROUND
  Hepatocellular cancer (HCC) is a leading cause of mortality worldwide. Liver resection or transplantation offer the best chance of long-term survival. The aim of this study was to perform a survival and prognostic factor analysis on patients who underwent resection of HCC at two major tertiary referral hospitals, and to investigate a pre-operative prediction model for microvascular invasion (MVI).
  
  
  METHODS
  Clinico-pathological and survival data were collected from all patients who underwent liver resection for HCC at two tertiary referral centres (Royal North Shore/North Shore Private Hospitals and Westmead Hospital) from 1998 to 2012. An overall and disease-free survival analysis was performed and a predictive model for MVI identified.
  
  
  RESULTS
  The total number of patients in this series was 125 and the 5-year overall and disease-free survival rates were 56% and 37%, respectively. MVI was the only factor to be independently associated with a poor prognosis on both overall and disease-free survival. Age ≥64 years, a serum alpha-fetoprotein (AFP) ≥400 ng/ml (×40 above normal) and tumor size ≥50 mm were independently associated with MVI. An MVI prediction model using these three pre-operative factors provides a good assessment of the risk of MVI.
  
  
  CONCLUSIONS
  MVI in the resected specimen of patients with HCC is associated with a poor prognosis. A preoperative MVI prediction model offers a useful way to identify patients at risk of relapse. However, more precise predictive models using molecular and genetic variables are needed to improve selection of patients most suitable for radical surgical treatment.
authors.affiliation: Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, Australia.
authors.forename: S M
authors.initials: SM
authors.lastname: Schlichtemeier
authors.affiliation: Department of Upper Gastrointestinal Surgery, Westmead Hospital, Australia; Discipline of Surgery, University of Sydney, Australia.
authors.forename: T C
authors.initials: TC
authors.lastname: Pang
authors.affiliation: Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, Australia.
authors.forename: N E
authors.initials: NE
authors.lastname: Williams
authors.affiliation: Department of Anatomical Pathology, Royal North Shore Hospital and Cancer Diagnosis and Pathology Research Group, Kolling Institute of Medical Research, Royal North Shore Hospital, Australia; Discipline of Surgery, University of Sydney, Australia.
authors.forename: A J
authors.initials: AJ
authors.lastname: Gill
authors.affiliation: Discipline of Surgery, University of Sydney, Australia.
authors.forename: R C
authors.initials: RC
authors.lastname: Smith
authors.affiliation: Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, Australia; Discipline of Surgery, University of Sydney, Australia.
authors.forename: J S
authors.initials: JS
authors.lastname: Samra
authors.affiliation: Department of Upper Gastrointestinal Surgery, Westmead Hospital, Australia; Discipline of Surgery, University of Sydney, Australia.
authors.forename: V W T
authors.initials: VW
authors.lastname: Lam
authors.affiliation: Department of Upper Gastrointestinal Surgery, Westmead Hospital, Australia; Discipline of Surgery, University of Sydney, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Hollands
authors.affiliation: Department of Upper Gastrointestinal Surgery, Westmead Hospital, Australia; Discipline of Surgery, University of Sydney, Australia.
authors.forename: A J
authors.initials: AJ
authors.lastname: Richardson
authors.affiliation: Department of Upper Gastrointestinal Surgery, Westmead Hospital, Australia; Discipline of Surgery, University of Sydney, Australia.
authors.forename: H C
authors.initials: HC
authors.lastname: Pleass
authors.affiliation: Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Nozawa
authors.affiliation: Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Albania
authors.affiliation: Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, Australia; Discipline of Surgery, University of Sydney, Australia. Electronic address: tom.hugh@sydney.edu.au.
authors.forename: T J
authors.initials: TJ
authors.lastname: Hugh
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D055806:Microvessels / Q000473:pathology; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Hepatocellular cancer; Liver resection; Microvascular invasion