Brief Articles
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Jun 7, 2009; 15(21): 2632-2637
Published online Jun 7, 2009. doi: 10.3748/wjg.15.2632
Prognosis of hepatocellular carcinoma accompanied by microscopic portal vein invasion
Ken Shirabe, Kiyoshi Kajiyama, Norifumi Harimoto, Hideaki Masumoto, Tatsuro Fukuya, Masafumi Ooya, Yoshihiko Maehara
Ken Shirabe, Department of Hepatogastroenterological Surgery, Aso Iizuka Hospital, Iizuka 820-8505, Japan
Ken Shirabe, Yoshihiko Maehara, Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
Kiyoshi Kajiyama, Norifumi Harimoto, Department of Surgery, Aso Iizuka Hospital, Iizuka 820-8505, Japan
Hideaki Masumoto, Department of Hepatology, Aso Iizuka Hospital, Iizuka 820-8505, Japan
Tatsuro Fukuya, Masafumi Ooya, Department of Radiology, Aso Iizuka Hospital, Iizuka 820-8505, Japan
Author contributions: Shirabe K performed the majority of the data analysis; Harimoto N and Masumoto H provided the clinical data; Kajiyama K and Ooya M provided the pathological data; Fukuya T provided radiographic diagnosis; Maehara Y reviewed the manuscript; Shirabe K designed the study and wrote the manuscript.
Correspondence to: Ken Shirabe, MD, PhD, FACS, Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. kshirabe@surg2.med.kyushu-u.ac.jp
Telephone: +81-92-6425466    
Fax: +81-92-6425482
Received: December 19, 2008
Revised: April 24, 2009
Accepted: May 1, 2009
Published online: June 7, 2009
Abstract

AIM: To investigate the prognostic factors in patients with hepatocellular carcinoma (HCC) accompanied by microscopic portal vein invasion (PVI).

METHODS: Of the 267 patients with HCC undergoing hepatic resection at Aso Iizuka Hospital, 71 had PVI. After excluding 16 patients with HCC that invaded the main trunk and the first and second branches of the portal vein, 55 patients with microscopic PVI were enrolled.

RESULTS: The patients with HCC accompanied by microscopic invasion were divided into two groups: solitary PVI (PVI-S: n = 44), and multiple PVIs (PVI-M: n = 11). The number of portal vein branches invaded by tumor thrombi was 5.4 ± 3.8 (2-16) in patients with PVI-M. In cumulative survival, PVI-M was found to be a significantly poor prognostic factor (P = 0.0019); while PVI-M and non-anatomical resection were significantly poor prognostic factors in disease-free survival (P = 0.0213, and 0.0115, respectively). In patients with PVI-M, multiple intrahepatic recurrence was more common than in the patients with PVI-S (P = 0.0049). In patients with PVI-S, non-anatomical resection was a significantly poor prognostic factor in disease-free survival (P = 0.0370). Operative procedure was not a significant prognostic factor in patients with PVI-M.

CONCLUSION: The presence of PVI-M was a poor prognostic factor in patients with HCC, accompanied by microscopic PVI. Anatomical resection is recommended in these patients with HCC. Patients with HCC and PVI-M may also be good candidates for adjuvant chemotherapy.

Keywords: Hepatocellular carcinoma; Microscopic portal vein invasion; Hepatectomy; Prognosis; Recurrence