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Milan Criteria, Multi-nodularity, and Microvascular Invasion Predict the Recurrence Patterns of Hepatocellular Carcinoma After Resection |
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| Authors: | Hung-Hsu Hung Hao-Jan Lei Gar-Yang Chau Chien-Wei Su Cheng-Yuan Hsia Wei-Yu Kao Wing-Yiu Lui Wen-Chieh Wu Han-Chieh Lin Jaw-Ching Wu |
| Institution: | 1. Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, 201, Shih-Pai Road, Sec. 2, Taipei, 112, Taiwan 2. Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan 3. Division of Gastroenterology, Department of Medicine, Cheng Hsin General Hospital, Taipei, Taiwan 4. Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, 201 Shih-Pai Road, Sec. 2, Taipei, 112, Taiwan 5. Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan 6. Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital—Taoyuan Branch, Taipei, Taiwan 7. Division of General Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan 8. Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan |
| Abstract: | AimsThis study aims to evaluate the risk factors for tumor recurrence beyond the Milan criteria (MC) for patients with hepatocellular carcinoma (HCC) after surgical resection (SR) in which salvage liver transplantation is relatively contraindicated.MethodsA total of 447 patients who underwent SR for HCC were enrolled consecutively. Among them, 248 and 199 patients were within the Milan criteria and beyond the Milan criteria (BMC group), respectively. Overall survival, recurrence, and disease-free survival were analyzed by multivariate analysis.ResultsAfter a median follow-up of 34.4 months, 130 patients died. Microvascular invasion, higher Edmondson stage of tumor cell differentiation, BMC group, and no anti-viral therapy were associated with poor overall survival. Multi-nodularity, higher Edmondson stage, BMC group, and no anti-viral therapy were independent risk factors for tumor recurrence, while BMC group and no anti-viral therapy were independent risk factors for disease-free survival. The Milan criteria, multi-nodularity, and microvascular invasion were used to stratify the patients into low-, medium-, and high-risk groups for tumor recurrence outside the MC and showed statistical significance (low vs. medium, p?=?0.011; low vs. high, p?<?0.001; medium vs. high, p?=?0.009).ConclusionsThe combination of the MC, multi-nodularity, and microvascular invasion predict the post-operative recurrence of HCC and may provide a roadmap for further treatment. |
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