Predictors of Micrometastases in Patients with Barcelona Clinic Liver Cancer Classification B Hepatocellular Carcinoma.
10.3349/ymj.2017.58.4.737
- Author:
Suk Won SUH
1
;
Yoo Shin CHOI
Author Information
1. Department of Surgery, College of Medicine, Chung-Ang University, Seoul, Korea. ushinchoi@hotmail.com
- Publication Type:Original Article
- Keywords:
Predictors;
micrometastases;
Barcelona Clinic Liver Cancer classification B hepatocellular carcinoma;
surgical resection;
transarterial chemoembolization
- MeSH:
Carcinoma, Hepatocellular*;
Classification*;
Humans;
Liver Neoplasms*;
Liver*;
Neoplasm Micrometastasis*;
Prothrombin;
Recurrence;
Risk Factors;
Vitamin K
- From:Yonsei Medical Journal
2017;58(4):737-742
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: Transarterial chemoembolization (TACE) is indicated for Barcelona Clinic Liver Cancer (BCLC) B hepatocellular carcinoma (HCC). Whether TACE provides any long-term survival benefits remains unclear. We aimed to investigate micrometastases predictors with which to identify patients who would benefit from surgical resection (SR). MATERIALS AND METHODS: First, we analyzed risk factors of micrometastases, microvascular invasion, and poor histologic grade in 38 patients with newly diagnosed resectable BCLC stage B HCC limited to one or two segments with well-preserved liver function and who underwent SR between January 2006 and December 2013. Second, we validated identified risk factors in 54 newly diagnosed resectable BCLC B HCC patients with well-preserved liver function who underwent TACE during the same period to determine their influence on survival. RESULTS: Risk factors of micrometastases in SR patients were α-fetoprotein (AFP) ≥110 [hazard ratio (HR)=5.166; 95% confidence interval (CI), 1.031–25.897; p=0.046] and prothrombin induced by vitamin K absence-II (PIVKA-II) ≥800 (HR=5.166; 95% CI, 1.031–25.897; p=0.046). The cumulative probability of tumor recurrence (p=0.009) after SR differed according to levels of AFP and PIVKA-II. After validation of these risk factors in the TACE group, patients with SR and AFP <110 and PIVKA-II <800 had superior survival outcomes than other patients (HR=0.116; 95% CI, 0.027–0.497; p=0.004). CONCLUSION: AFP and PIVKA-II levels predict micrometastases and survival. Therefore, they should be considered when selecting SR for BCLC B HCC.
