TY - JOUR
T1 - Milan Criteria, Multi-nodularity, and Microvascular Invasion Predict the Recurrence Patterns of Hepatocellular Carcinoma After Resection
AU - Hung, Hung Hsu
AU - Lei, Hao Jan
AU - Chau, Gar Yang
AU - Su, Chien Wei
AU - Hsia, Cheng Yuan
AU - Kao, Wei Yu
AU - Lui, Wing Yiu
AU - Wu, Wen Chieh
AU - Lin, Han Chieh
AU - Wu, Jaw Ching
N1 - Funding Information:
Acknowledgments This study was supported by grants from the National Science Council (NSC 100-2314-B-075-073 and NSC101-2314-B-075-013-MY2), Taipei Veterans General Hospital (V99C1-025), and Center of Excellence for Cancer Research at TVGH (DOH100-TD-C-111-007), Taipei, Taiwan.
PY - 2013/1/1
Y1 - 2013/1/1
N2 - Aims: This study aims to evaluate the risk factors for tumor recurrence beyond the Milan criteria (MC) for patients with hepatocellular carcinoma (HCC) after surgical resection (SR) in which salvage liver transplantation is relatively contraindicated. Methods: A total of 447 patients who underwent SR for HCC were enrolled consecutively. Among them, 248 and 199 patients were within the Milan criteria and beyond the Milan criteria (BMC group), respectively. Overall survival, recurrence, and disease-free survival were analyzed by multivariate analysis. Results: After a median follow-up of 34. 4 months, 130 patients died. Microvascular invasion, higher Edmondson stage of tumor cell differentiation, BMC group, and no anti-viral therapy were associated with poor overall survival. Multi-nodularity, higher Edmondson stage, BMC group, and no anti-viral therapy were independent risk factors for tumor recurrence, while BMC group and no anti-viral therapy were independent risk factors for disease-free survival. The Milan criteria, multi-nodularity, and microvascular invasion were used to stratify the patients into low-, medium-, and high-risk groups for tumor recurrence outside the MC and showed statistical significance (low vs. medium, p = 0. 011; low vs. high, p & 0. 001; medium vs. high, p = 0. 009). Conclusions: The combination of the MC, multi-nodularity, and microvascular invasion predict the post-operative recurrence of HCC and may provide a roadmap for further treatment.
AB - Aims: This study aims to evaluate the risk factors for tumor recurrence beyond the Milan criteria (MC) for patients with hepatocellular carcinoma (HCC) after surgical resection (SR) in which salvage liver transplantation is relatively contraindicated. Methods: A total of 447 patients who underwent SR for HCC were enrolled consecutively. Among them, 248 and 199 patients were within the Milan criteria and beyond the Milan criteria (BMC group), respectively. Overall survival, recurrence, and disease-free survival were analyzed by multivariate analysis. Results: After a median follow-up of 34. 4 months, 130 patients died. Microvascular invasion, higher Edmondson stage of tumor cell differentiation, BMC group, and no anti-viral therapy were associated with poor overall survival. Multi-nodularity, higher Edmondson stage, BMC group, and no anti-viral therapy were independent risk factors for tumor recurrence, while BMC group and no anti-viral therapy were independent risk factors for disease-free survival. The Milan criteria, multi-nodularity, and microvascular invasion were used to stratify the patients into low-, medium-, and high-risk groups for tumor recurrence outside the MC and showed statistical significance (low vs. medium, p = 0. 011; low vs. high, p & 0. 001; medium vs. high, p = 0. 009). Conclusions: The combination of the MC, multi-nodularity, and microvascular invasion predict the post-operative recurrence of HCC and may provide a roadmap for further treatment.
KW - Hepatocellular carcinoma
KW - Liver transplantation
KW - Milan criteria
KW - Surgical resection
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U2 - 10.1007/s11605-012-2087-z
DO - 10.1007/s11605-012-2087-z
M3 - Article
C2 - 23225107
AN - SCOPUS:84875050821
SN - 1091-255X
VL - 17
SP - 702
EP - 711
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
IS - 4
ER -