Microvascular Infiltration has Limited Clinical Value for Treatment and Prognosis in Hepatocellular Carcinoma
Background Microvascular infiltration (MVI) is considered a necessary step in the metastatic evolution of hepatocellular carcinoma (HCC), but its prognostic value after liver resection (LR) is uncertain. We studied the clinical value of MVI compared to the Milan criteria in a consecutive series of p...
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| Veröffentlicht in: | World journal of surgery 2014-07, Vol.38 (7), p.1769-1776 |
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| creator | Portolani, Nazario Baiocchi, Gian Luca Molfino, Sarah Benetti, Anna Gheza, Federico Giulini, Stefano Maria |
| description | Background
Microvascular infiltration (MVI) is considered a necessary step in the metastatic evolution of hepatocellular carcinoma (HCC), but its prognostic value after liver resection (LR) is uncertain. We studied the clinical value of MVI compared to the Milan criteria in a consecutive series of patients submitted to radical LR.
Methods
A total of 441 patients were retrospectively evaluated. MVI and the Milan criteria were analyzed and compared as prognostic factors for overall and disease-free survival (DFS).
Results
MVI was present in 189 patients (42.8 %). Grading, satellitosis, size of cancer, and alfa fetoprotein value were significantly related to MVI, which was present in 34.3 and 53.2 % of Milan+ and Milan− patients, respectively (
p
= 0.00001). Both MVI and the Milan criteria were associated with a lower overall and DFS, but only the Milan criteria were associated with the rate of early recurrence and the feasibility of a curative treatment of the recurrence. The application of MVI parameters to patients classified by the Milan criteria further selects the outcome in Milan+ patients (5-year survival rate of 54.1 and 67.9 %, respectively, in the presence or absence of MVI) but not in Milan− patients.
Conclusions
MVI is related to survival after LR for HCC, but the clinical value of this information is limited. In Milan+ patients, the absence of MVI selects the cases with better prognosis. In the presence of a liver recurrence, the Milan criteria related to the primary HCC show a better prognostic accuracy and have clinical relevance in the decision-making process. |
| doi_str_mv | 10.1007/s00268-013-2426-6 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1548632352</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3383417861</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4926-ef2630756c6c47867f031a62601af149f72b3efc6a32582bfdf502ef28b2325c3</originalsourceid><addsrcrecordid>eNqFkU9v1DAUxC0EotvCB-CCLHHhEvC_vCRHWFFatAgkChytt167uHLsxU5A_fb1NgUhJMTJPvxmNG-GkCecveCMdS8LYwL6hnHZCCWggXtkxZUUjZBC3icrJkHVP5dH5LiUK8Z4BwwekiOhZNe3aliR8b03Of3AYuaAmZ5H58OUcfIp0m9Y6MaPfrI7ug4-eoOBfsEwW-pSphfZ4jTaOFGMO_oxp8uYii_UR3pm9zglY0O4dV1jNj6mER-RBw5DsY_v3hPy-fTNxfqs2Xx4e75-tWmMGuod1gmQrGvBgFFdD51jkiMIYBwdV4PrxFZaZwClaHuxdTvXMlFV_bZe3hp5Qp4vvvucvs-2THr05RAHo01z0bxVPdSOWlHRZ3-hV2nOsaa7pXjHB9VWii9ULauUbJ3eZz9ivtac6cMWetlC1y30YQsNVfP0znnejnb3W_Gr_AoMC_DTB3v9f0f99d2n16cMejiYi0Vbqixe2vxH7H8mugEcIqTs</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1548171945</pqid></control><display><type>article</type><title>Microvascular Infiltration has Limited Clinical Value for Treatment and Prognosis in Hepatocellular Carcinoma</title><source>MEDLINE</source><source>Wiley Online Library Journals</source><source>SpringerNature Complete Journals</source><creator>Portolani, Nazario ; Baiocchi, Gian Luca ; Molfino, Sarah ; Benetti, Anna ; Gheza, Federico ; Giulini, Stefano Maria</creator><creatorcontrib>Portolani, Nazario ; Baiocchi, Gian Luca ; Molfino, Sarah ; Benetti, Anna ; Gheza, Federico ; Giulini, Stefano Maria</creatorcontrib><description>Background
Microvascular infiltration (MVI) is considered a necessary step in the metastatic evolution of hepatocellular carcinoma (HCC), but its prognostic value after liver resection (LR) is uncertain. We studied the clinical value of MVI compared to the Milan criteria in a consecutive series of patients submitted to radical LR.
Methods
A total of 441 patients were retrospectively evaluated. MVI and the Milan criteria were analyzed and compared as prognostic factors for overall and disease-free survival (DFS).
Results
MVI was present in 189 patients (42.8 %). Grading, satellitosis, size of cancer, and alfa fetoprotein value were significantly related to MVI, which was present in 34.3 and 53.2 % of Milan+ and Milan− patients, respectively (
p
= 0.00001). Both MVI and the Milan criteria were associated with a lower overall and DFS, but only the Milan criteria were associated with the rate of early recurrence and the feasibility of a curative treatment of the recurrence. The application of MVI parameters to patients classified by the Milan criteria further selects the outcome in Milan+ patients (5-year survival rate of 54.1 and 67.9 %, respectively, in the presence or absence of MVI) but not in Milan− patients.
Conclusions
MVI is related to survival after LR for HCC, but the clinical value of this information is limited. In Milan+ patients, the absence of MVI selects the cases with better prognosis. In the presence of a liver recurrence, the Milan criteria related to the primary HCC show a better prognostic accuracy and have clinical relevance in the decision-making process.</description><identifier>ISSN: 0364-2313</identifier><identifier>EISSN: 1432-2323</identifier><identifier>DOI: 10.1007/s00268-013-2426-6</identifier><identifier>PMID: 24378549</identifier><language>eng</language><publisher>Boston: Springer US</publisher><subject>Abdominal Surgery ; Adult ; Aged ; Aged, 80 and over ; alpha-Fetoproteins - metabolism ; Carcinoma, Hepatocellular - blood ; Carcinoma, Hepatocellular - mortality ; Carcinoma, Hepatocellular - secondary ; Carcinoma, Hepatocellular - surgery ; Cardiac Surgery ; Disease-Free Survival ; Early Recurrence ; Female ; General Surgery ; Hepatectomy - mortality ; Humans ; Liver - blood supply ; Liver Neoplasms - blood ; Liver Neoplasms - mortality ; Liver Neoplasms - pathology ; Liver Neoplasms - surgery ; Liver Resection ; Male ; Medicine ; Medicine & Public Health ; Microvessels - pathology ; Middle Aged ; Neoplasm Grading ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local - mortality ; Neoplasm Recurrence, Local - pathology ; Neoplasm Recurrence, Local - surgery ; Orthotopic Liver Transplantation ; Overall Survival ; Percutaneous Ethanol Injection ; Prognosis ; Retrospective Studies ; Surgery ; Survival Rate ; Thoracic Surgery ; Tumor Burden ; Vascular Surgery</subject><ispartof>World journal of surgery, 2014-07, Vol.38 (7), p.1769-1776</ispartof><rights>Société Internationale de Chirurgie 2013</rights><rights>2014 The Author(s) under exclusive licence to Société Internationale de Chirurgie</rights><rights>Société Internationale de Chirurgie 2014</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4926-ef2630756c6c47867f031a62601af149f72b3efc6a32582bfdf502ef28b2325c3</citedby><cites>FETCH-LOGICAL-c4926-ef2630756c6c47867f031a62601af149f72b3efc6a32582bfdf502ef28b2325c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00268-013-2426-6$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00268-013-2426-6$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,41464,42533,45550,45551,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24378549$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Portolani, Nazario</creatorcontrib><creatorcontrib>Baiocchi, Gian Luca</creatorcontrib><creatorcontrib>Molfino, Sarah</creatorcontrib><creatorcontrib>Benetti, Anna</creatorcontrib><creatorcontrib>Gheza, Federico</creatorcontrib><creatorcontrib>Giulini, Stefano Maria</creatorcontrib><title>Microvascular Infiltration has Limited Clinical Value for Treatment and Prognosis in Hepatocellular Carcinoma</title><title>World journal of surgery</title><addtitle>World J Surg</addtitle><addtitle>World J Surg</addtitle><description>Background
Microvascular infiltration (MVI) is considered a necessary step in the metastatic evolution of hepatocellular carcinoma (HCC), but its prognostic value after liver resection (LR) is uncertain. We studied the clinical value of MVI compared to the Milan criteria in a consecutive series of patients submitted to radical LR.
Methods
A total of 441 patients were retrospectively evaluated. MVI and the Milan criteria were analyzed and compared as prognostic factors for overall and disease-free survival (DFS).
Results
MVI was present in 189 patients (42.8 %). Grading, satellitosis, size of cancer, and alfa fetoprotein value were significantly related to MVI, which was present in 34.3 and 53.2 % of Milan+ and Milan− patients, respectively (
p
= 0.00001). Both MVI and the Milan criteria were associated with a lower overall and DFS, but only the Milan criteria were associated with the rate of early recurrence and the feasibility of a curative treatment of the recurrence. The application of MVI parameters to patients classified by the Milan criteria further selects the outcome in Milan+ patients (5-year survival rate of 54.1 and 67.9 %, respectively, in the presence or absence of MVI) but not in Milan− patients.
Conclusions
MVI is related to survival after LR for HCC, but the clinical value of this information is limited. In Milan+ patients, the absence of MVI selects the cases with better prognosis. In the presence of a liver recurrence, the Milan criteria related to the primary HCC show a better prognostic accuracy and have clinical relevance in the decision-making process.</description><subject>Abdominal Surgery</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>alpha-Fetoproteins - metabolism</subject><subject>Carcinoma, Hepatocellular - blood</subject><subject>Carcinoma, Hepatocellular - mortality</subject><subject>Carcinoma, Hepatocellular - secondary</subject><subject>Carcinoma, Hepatocellular - surgery</subject><subject>Cardiac Surgery</subject><subject>Disease-Free Survival</subject><subject>Early Recurrence</subject><subject>Female</subject><subject>General Surgery</subject><subject>Hepatectomy - mortality</subject><subject>Humans</subject><subject>Liver - blood supply</subject><subject>Liver Neoplasms - blood</subject><subject>Liver Neoplasms - mortality</subject><subject>Liver Neoplasms - pathology</subject><subject>Liver Neoplasms - surgery</subject><subject>Liver Resection</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Microvessels - pathology</subject><subject>Middle Aged</subject><subject>Neoplasm Grading</subject><subject>Neoplasm Invasiveness</subject><subject>Neoplasm Recurrence, Local - mortality</subject><subject>Neoplasm Recurrence, Local - pathology</subject><subject>Neoplasm Recurrence, Local - surgery</subject><subject>Orthotopic Liver Transplantation</subject><subject>Overall Survival</subject><subject>Percutaneous Ethanol Injection</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><subject>Survival Rate</subject><subject>Thoracic Surgery</subject><subject>Tumor Burden</subject><subject>Vascular Surgery</subject><issn>0364-2313</issn><issn>1432-2323</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqFkU9v1DAUxC0EotvCB-CCLHHhEvC_vCRHWFFatAgkChytt167uHLsxU5A_fb1NgUhJMTJPvxmNG-GkCecveCMdS8LYwL6hnHZCCWggXtkxZUUjZBC3icrJkHVP5dH5LiUK8Z4BwwekiOhZNe3aliR8b03Of3AYuaAmZ5H58OUcfIp0m9Y6MaPfrI7ug4-eoOBfsEwW-pSphfZ4jTaOFGMO_oxp8uYii_UR3pm9zglY0O4dV1jNj6mER-RBw5DsY_v3hPy-fTNxfqs2Xx4e75-tWmMGuod1gmQrGvBgFFdD51jkiMIYBwdV4PrxFZaZwClaHuxdTvXMlFV_bZe3hp5Qp4vvvucvs-2THr05RAHo01z0bxVPdSOWlHRZ3-hV2nOsaa7pXjHB9VWii9ULauUbJ3eZz9ivtac6cMWetlC1y30YQsNVfP0znnejnb3W_Gr_AoMC_DTB3v9f0f99d2n16cMejiYi0Vbqixe2vxH7H8mugEcIqTs</recordid><startdate>201407</startdate><enddate>201407</enddate><creator>Portolani, Nazario</creator><creator>Baiocchi, Gian Luca</creator><creator>Molfino, Sarah</creator><creator>Benetti, Anna</creator><creator>Gheza, Federico</creator><creator>Giulini, Stefano Maria</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>201407</creationdate><title>Microvascular Infiltration has Limited Clinical Value for Treatment and Prognosis in Hepatocellular Carcinoma</title><author>Portolani, Nazario ; Baiocchi, Gian Luca ; Molfino, Sarah ; Benetti, Anna ; Gheza, Federico ; Giulini, Stefano Maria</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4926-ef2630756c6c47867f031a62601af149f72b3efc6a32582bfdf502ef28b2325c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Abdominal Surgery</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>alpha-Fetoproteins - metabolism</topic><topic>Carcinoma, Hepatocellular - blood</topic><topic>Carcinoma, Hepatocellular - mortality</topic><topic>Carcinoma, Hepatocellular - secondary</topic><topic>Carcinoma, Hepatocellular - surgery</topic><topic>Cardiac Surgery</topic><topic>Disease-Free Survival</topic><topic>Early Recurrence</topic><topic>Female</topic><topic>General Surgery</topic><topic>Hepatectomy - mortality</topic><topic>Humans</topic><topic>Liver - blood supply</topic><topic>Liver Neoplasms - blood</topic><topic>Liver Neoplasms - mortality</topic><topic>Liver Neoplasms - pathology</topic><topic>Liver Neoplasms - surgery</topic><topic>Liver Resection</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Microvessels - pathology</topic><topic>Middle Aged</topic><topic>Neoplasm Grading</topic><topic>Neoplasm Invasiveness</topic><topic>Neoplasm Recurrence, Local - mortality</topic><topic>Neoplasm Recurrence, Local - pathology</topic><topic>Neoplasm Recurrence, Local - surgery</topic><topic>Orthotopic Liver Transplantation</topic><topic>Overall Survival</topic><topic>Percutaneous Ethanol Injection</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><topic>Survival Rate</topic><topic>Thoracic Surgery</topic><topic>Tumor Burden</topic><topic>Vascular Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Portolani, Nazario</creatorcontrib><creatorcontrib>Baiocchi, Gian Luca</creatorcontrib><creatorcontrib>Molfino, Sarah</creatorcontrib><creatorcontrib>Benetti, Anna</creatorcontrib><creatorcontrib>Gheza, Federico</creatorcontrib><creatorcontrib>Giulini, Stefano Maria</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>World journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Portolani, Nazario</au><au>Baiocchi, Gian Luca</au><au>Molfino, Sarah</au><au>Benetti, Anna</au><au>Gheza, Federico</au><au>Giulini, Stefano Maria</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Microvascular Infiltration has Limited Clinical Value for Treatment and Prognosis in Hepatocellular Carcinoma</atitle><jtitle>World journal of surgery</jtitle><stitle>World J Surg</stitle><addtitle>World J Surg</addtitle><date>2014-07</date><risdate>2014</risdate><volume>38</volume><issue>7</issue><spage>1769</spage><epage>1776</epage><pages>1769-1776</pages><issn>0364-2313</issn><eissn>1432-2323</eissn><abstract>Background
Microvascular infiltration (MVI) is considered a necessary step in the metastatic evolution of hepatocellular carcinoma (HCC), but its prognostic value after liver resection (LR) is uncertain. We studied the clinical value of MVI compared to the Milan criteria in a consecutive series of patients submitted to radical LR.
Methods
A total of 441 patients were retrospectively evaluated. MVI and the Milan criteria were analyzed and compared as prognostic factors for overall and disease-free survival (DFS).
Results
MVI was present in 189 patients (42.8 %). Grading, satellitosis, size of cancer, and alfa fetoprotein value were significantly related to MVI, which was present in 34.3 and 53.2 % of Milan+ and Milan− patients, respectively (
p
= 0.00001). Both MVI and the Milan criteria were associated with a lower overall and DFS, but only the Milan criteria were associated with the rate of early recurrence and the feasibility of a curative treatment of the recurrence. The application of MVI parameters to patients classified by the Milan criteria further selects the outcome in Milan+ patients (5-year survival rate of 54.1 and 67.9 %, respectively, in the presence or absence of MVI) but not in Milan− patients.
Conclusions
MVI is related to survival after LR for HCC, but the clinical value of this information is limited. In Milan+ patients, the absence of MVI selects the cases with better prognosis. In the presence of a liver recurrence, the Milan criteria related to the primary HCC show a better prognostic accuracy and have clinical relevance in the decision-making process.</abstract><cop>Boston</cop><pub>Springer US</pub><pmid>24378549</pmid><doi>10.1007/s00268-013-2426-6</doi><tpages>8</tpages></addata></record> |
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| ispartof | World journal of surgery, 2014-07, Vol.38 (7), p.1769-1776 |
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| subjects | Abdominal Surgery Adult Aged Aged, 80 and over alpha-Fetoproteins - metabolism Carcinoma, Hepatocellular - blood Carcinoma, Hepatocellular - mortality Carcinoma, Hepatocellular - secondary Carcinoma, Hepatocellular - surgery Cardiac Surgery Disease-Free Survival Early Recurrence Female General Surgery Hepatectomy - mortality Humans Liver - blood supply Liver Neoplasms - blood Liver Neoplasms - mortality Liver Neoplasms - pathology Liver Neoplasms - surgery Liver Resection Male Medicine Medicine & Public Health Microvessels - pathology Middle Aged Neoplasm Grading Neoplasm Invasiveness Neoplasm Recurrence, Local - mortality Neoplasm Recurrence, Local - pathology Neoplasm Recurrence, Local - surgery Orthotopic Liver Transplantation Overall Survival Percutaneous Ethanol Injection Prognosis Retrospective Studies Surgery Survival Rate Thoracic Surgery Tumor Burden Vascular Surgery |
| title | Microvascular Infiltration has Limited Clinical Value for Treatment and Prognosis in Hepatocellular Carcinoma |
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