Preoperative radiologic and postoperative pathologic risk factors for early intra-hepatic recurrence in hepatocellular carcinoma patients who underwent curative resection

• Published in: Yonsei medical journal 2009, 50(6), , pp.789-795
• Main Authors: Kim, Honsoul, Park, Mi-Suk, Park, Young Nyun, Kim, Hyunki, Kim, Kyung Sik, Choi, Jin Sub, Ahn, Sang Hoon, Han, Kwang-Hyub, Kim, Myeong-Jin, Kim, Ki Whang
• Format: Article
• Language: English
• Subjects: Adult; Aged; alpha-Fetoproteins - metabolism; Carcinoma, Hepatocellular - diagnostic imaging; Carcinoma, Hepatocellular - metabolism; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - surgery; Female; Humans; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - metabolism; Liver Neoplasms - pathology; Liver Neoplasms - surgery; Male; Middle Aged; Neoplasm Recurrence, Local - diagnostic imaging; Neoplasm Recurrence, Local - metabolism; Neoplasm Recurrence, Local - pathology; Original; Retrospective Studies; Risk Factors; Tomography, X-Ray Computed; 의학일반
• ISSN: 0513-5796; 1976-2437
• DOI: 10.3349/ymj.2009.50.6.789

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. 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. 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. 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.