Preoperative Radiologic and Postoperative Pathologic Risk Factors for Early Intra-Hepatic Recurrence in Hepatocellular Carcinoma Patients Who Underwent Curative Resection.
10.3349/ymj.2009.50.6.789
- Author:
Honsoul KIM
1
;
Mi Suk PARK
;
Young Nyun PARK
;
Hyunki KIM
;
Kyung Sik KIM
;
Jin Sub CHOI
;
Sang Hoon AHN
;
Kwang Hyub HAN
;
Myeong Jin KIM
;
Ki Whang KIM
Author Information
1. Department of Diagnostic Radiology, Institute of Gastroenterology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea. radpms@yuhs.ac
- Publication Type:Original Article
- Keywords:
Hepatocellular carcinoma;
preoperative CT;
postoperative pathologic findings;
early recurrence;
curative resection
- MeSH:
Adult;
Aged;
Carcinoma, Hepatocellular/metabolism/pathology/*radiography/*surgery;
Female;
Humans;
Liver Neoplasms/metabolism/pathology/*radiography/*surgery;
Male;
Middle Aged;
Neoplasm Recurrence, Local/metabolism/*pathology/*radiography;
Retrospective Studies;
Risk Factors;
Tomography, X-Ray Computed;
alpha-Fetoproteins/metabolism
- From:Yonsei Medical Journal
2009;50(6):789-795
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: The risk of hepatocellular carcinoma (HCC) recurrence must be considered ahead of surgery. This study was undertaken to identify pre-operative risk factors for early intrahepatic recurrence of HCC after curative resection in a large-scale. MATERIALS AND METHODS: We retrospectively reviewed the preoperative three-phase multi-detector CT (MDCT) and laboratory data for 240 HCC patients who underwent curative resection; tumor size, number, gross shape, capsule integrity, distinctiveness of tumor margin, portal vein thrombosis (PVT), alpha-fetoprotein level (AFP), and protein induced by vitamin K absence-II (PIVKA-II) levels were assessed. Surgical pathology was reviewed; tumor differentiation, capsule, necrosis, and micro-vessel invasion were recorded. RESULTS: HCC recurred in 61 patients within six months (early recurrence group), but not in 179 patients (control group). In univariate analysis, large tumor size (p = 0.018), shape (p = 0.028), poor capsule integrity (p = 0.046), elevated AFP (p = 0.015), and PIVKA-II (p = 0.008) were significant preoperative risk factors. Among the pathologic features, PVT (p = 0.023), Glisson's capsule penetration (p = 0.033), microvascular invasion (p < 0.001), and poor differentiation (p = 0.001) showed statistical significance. In multivariate analysis, only the histopathologic parameters of microvascular invasion and poor differentiation achieved statistical significance. CONCLUSION: Preoperative CT and laboratory parameters showed limited value, while the presence of microscopic vascular tumor invasion and poorly differentiated HCC correlated with higher risk of early recurrence after curative resection.
