title: Clinicopathological Characteristics of Hepatocellular Carcinoma with Microscopic Portal Venous Invasion and the Role of Anatomical Liver Resection in These Cases.
abstract: The aims of this study were to investigate predictive factors for microscopic portal venous invasion (mPVI) in hepatocellular carcinoma (HCC) and whether anatomical liver resection (ALR) was useful in such cases.
  
  
  
  We analyzed 852 patients with HCC without macroscopic portal venous invasion who were treated at our hospital between January 1990 and May 2014. These patients were stratified into a microscopic portal venous invasion group (mPVI group; n = 153) and non-microscopic portal venous invasion group (NmPVI group; n = 699).
  
  
  
  PIVKA-II ≥100 mAU/ml, a tumor size ≥5 cm, a confluent lesion, and poor differentiation were found to be independent risk factors for mPVI. Among the mPVI group who had single HCC under 5 cm, serum albumin level <4.0 g/dl, PIVKA-II ≥100 mAU/ml, a positive surgical margin, and non-ALR (NALR) were independent unfavorable prognostic factors for overall survival (OS). PIVKA-II ≥100 mAU/ml, a positive surgical margin and NALR were independent unfavorable prognostic factors for relapse-free survival (RFS). ALR was significantly favorable factor for both OS and RFS of the mPVI group who had single HCC under 5 cm.
  
  
  
  Even if no portal venous invasion is detectable in HCC patients preoperatively, a PIVKA-II ≥100 mAU/ml, tumor size ≥5 cm, and a confluent lesion indicate a high risk of mPVI. ALR should be considered for the patients with these characteristics because it is a favorable prognostic factor in these cases with mPVI.
authors.affiliation: Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North15-West7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan. shingoshimada1979@true.ocn.ne.jp.
authors.forename: Shingo
authors.initials: S
authors.lastname: Shimada
authors.affiliation: Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North15-West7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan.
authors.forename: Toshiya
authors.initials: T
authors.lastname: Kamiyama
authors.affiliation: Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North15-West7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Yokoo
authors.affiliation: Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North15-West7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Orimo
authors.affiliation: Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North15-West7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Wakayama
authors.affiliation: Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North15-West7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Einama
authors.affiliation: Department of Surgery, Sapporo Kousei Hospital, Sapporo, Japan.
authors.forename: Tatsuhiko
authors.initials: T
authors.lastname: Kakisaka
authors.affiliation: Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North15-West7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kamachi
authors.affiliation: Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North15-West7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan.
authors.forename: Akinobu
authors.initials: A
authors.lastname: Taketomi
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D014408:Biomarkers, Tumor / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000473:pathology / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000097:blood / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011169:Portal Vein / Q000473:pathology*; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood; D011516:Prothrombin; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D014408:Biomarkers, Tumor; D011498:Protein Precursors; C008208:acarboxyprothrombin; D011516:Prothrombin