肝细胞癌微血管侵犯的新病理分层：预测活体肝移植后的预后

New Pathologic Stratification of Microvascular Invasion in Hepatocellular Carcinoma: Predicting Prognosis After Living-donor Liver Transplantation.

作者信息

Iguchi Tomohiro, Shirabe Ken, Aishima Shinichi, Wang Huanlin, Fujita Nobuhiro, Ninomiya Mizuki, Yamashita Yo-ichi, Ikegami Toru, Uchiyama Hideaki, Yoshizumi Tomoharu, Oda Yoshinao, Maehara Yoshihiko

机构信息

1 Department of Surgery and Science, Kyushu University, Fukuoka, Japan. 2 Department of Anatomic Pathology, Kyushu University, Fukuoka, Japan. 3 Department of Molecular Imaging and Diagnosis, Kyushu University, Fukuoka, Japan.

出版信息

Transplantation. 2015 Jun;99(6):1236-42. doi: 10.1097/TP.0000000000000489.

DOI:10.1097/TP.0000000000000489

PMID:25427164

Abstract

BACKGROUND

Vascular invasion of hepatocellular carcinoma (HCC) has a high incidence of recurrence after liver transplantation. Patients with microvascular invasion (MVI) show a high tumor grade; however, some show a good prognosis. This retrospective study aimed to investigate whether the degree of MVI affects prognosis after living-donor liver transplantation.

METHODS

A total of 142 patients with HCC who had undergone living-donor liver transplantation were histologically evaluated about the number of invaded vessels and the maximum number of invading carcinoma cells. Patients with MVI were classified into two subgroups: high MVI group (n = 38), which showed more than 50 carcinoma cells in the vessels, with multiple invaded vessels; and low MVI group (n = 17), which showed MVI, but not high MVI.

RESULTS

Analysis of recurrence-free survival showed that high MVI group had significantly poorer outcomes than the other groups (P < 0.001). High MVI group had significantly higher α-fetoprotein levels, des-γ-carboxy prothrombin levels, number of tumors, a larger tumor size, and a higher percentage of poorly differentiated HCC than non-MVI group. High MVI was an independent prognostic factor for recurrence-free survival (P = 0.030). Among patients exceeding the Milan criteria (n = 61), high MVI group had significantly poorer outcomes than the other groups for recurrence-free survival (P = 0.003). Patients in high MVI group had significantly higher des-γ-carboxy prothrombin levels and a larger tumor size than non-MVI group. High MVI was an independent prognostic factor for recurrence-free survival (P = 0.014).

CONCLUSION

In living-donor liver transplantation for HCC, high MVI is a novel pathologic marker for predicting prognosis.

摘要

背景

肝细胞癌（HCC）的血管侵犯在肝移植后复发率很高。微血管侵犯（MVI）患者的肿瘤分级较高；然而，一些患者预后良好。本回顾性研究旨在探讨MVI程度是否影响活体肝移植后的预后。

方法

对142例行活体肝移植的HCC患者进行组织学评估，观察侵袭血管数量及侵袭癌细胞的最大数量。MVI患者分为两个亚组：高MVI组（n = 38），血管内癌细胞超过50个，且有多条侵袭血管；低MVI组（n = 17），有MVI但不属于高MVI。

结果

无复发生存分析显示，高MVI组的预后明显比其他组差（P < 0.001）。高MVI组的甲胎蛋白水平、异常凝血酶原水平、肿瘤数量、肿瘤大小以及低分化HCC的比例均显著高于无MVI组。高MVI是无复发生存的独立预后因素（P = 0.030）。在超过米兰标准的患者（n = 61）中，高MVI组的无复发生存预后明显比其他组差（P = 0.003）。高MVI组患者的异常凝血酶原水平和肿瘤大小显著高于无MVI组。高MVI是无复发生存的独立预后因素（P = 0.014）。