Predictors of microvascular invasion in patients with hepatocellular carcinoma who are candidates for orthotopic liver transplantation |
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Authors: | Nestor F Esnaola MD MPH Gregory Y Lauwers MD Nadeem Q Mirza MD MPH David M Nagorney MD Dorota Doherty PhD Iwao Ikai MD Yoshio Yamaoka MD Jean-Marc Regimbeau MD Jacques Belghiti MD Steven A Curley MD Lee M Ellis MD J Nicolas Vauthey MD |
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Institution: | 1. Department of Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 2. Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts 3. Department of Surgery, Mayo Clinic, Rochester, Minnesota 4. Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 5. Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan 6. Department of Surgery, H?pital Beaujon, Paris, France
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Abstract: | Microvascular invasion affects survival after orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC). We
sought to identify preoperative predictors of microvascular invasion in patients with HCC who were candidates for OLT. A cohort
of 245 patients who underwent resection for HCC and fulfilled the criteria for OLT (i.e., single tumors ≤5 cm or no more than
three tumors S3 cm) were identified from a multi-institutional database. Thirty-three percent of the patients had pathologic
evidence of microvascular invasion. Thirty percent of patients with single tumors and 47% with multiple tumors had microvascular
invasion (P = 0.04). Only 25% of patients with tumors smaller than ≤2 cm had microvascular invasion, compared to 31% and 50%
with tumors greater than 2 to 4 cm or larger than 4 cm, respectively (P = 0.01). Tumor grade was highly correlated with microvascular
invasion: 12% of patients with well-differentiated tumors had microvascular invasion, compared to 29% and 50% with moderately
or poorly differentiated tumors, respectively (P < 0.001). The independent predictors of microvascular invasion were tumor
size greater than 4 cm (odds ratio OR], 3.0, 95% confidence interval CI], 1.2 to 7.1), and high tumor grade (OR, 6.3; 95%
CI, 2.0 to 19.9). Tumor size and grade are strong predictors of microvascular invasion. A tumor biopsy with pathologic grading
at the time of pretransplantation ablative therapy could improve selection of patients with HCC for OLT.
Presented at the Forty-Second Annual Meeting of The Society for Surgery of the Alimentary Tract, Atlanta, Georgia, May 20–23,
2001.
Supported by a T-32 Surgical Oncology Training Grant from the National Institutes of Health (N.F.E). |
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Keywords: | Hepatocellular carcinoma liver transplantation vascular invasion |
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