Clinical significance of microscopic tumor venous invasion in patients with resectable hepatocellular carcinoma

Tsai, Tzu-Jung; Chau, Gar‐Yang; Lui, Wing‐Yiu; Tsay, Shyh‐Haw; King, Kuang‐Liang; Loong, Che‐Chuan; Hsia, Cheng Yuan; Wu, Chew-Wun

doi:10.1067/msy.2000.105498

Cited by 250 publications

(209 citation statements)

References 16 publications

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“…28,29 The most powerful prognostic factor of poor survival was vascular invasion in this study, and similar results were reported in patients who underwent liver resection or transplantation. 1,[30][31][32] Although the BCLC system was validated as the most suitable prognostic system for patients with HCC in Italy and the United States, it was not considered a suitable prognostic system in the Eastern countries until now. 33,34 Furthermore, in the current study, surgical patients were excluded from the analysis, which may be an important reason that the BCLC system was inferior to the JIS system or the CLIP system in predicting the survival of patients with HCC.…”

Section: Discussionmentioning

confidence: 99%

Comparison of 7 staging systems for patients with hepatocellular carcinoma undergoing transarterial chemoembolization

Cho

Chung

Kim

et al. 2007

Cancer

110

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BACKGROUND.Many liver staging systems have been proposed for patients with hepatocellular carcinoma after locoregional therapy; however, controversies persist regarding which system is the best. In this study, the authors compared the performance of 7 staging systems in a cohort of patients with hepatocellular carcinoma who underwent transarterial chemoembolization.METHODS.In total, 131 patients with hepatocellular carcinoma who underwent transarterial chemoembolization between August 1998 and February 2005 were included in the study. Demographic, laboratory, and tumor characteristics were determined at diagnosis and before therapy. At the time of censorship, 109 patients had died (83.2%). Predictors of survival were identified by using the Cox proportional hazards model. The likelihood‐ratio chi‐square statistic and the Akaike Information Criterion were calculated for 7 prognostic systems to evaluate their discriminatory ability. Comparisons of the survival rate between each stage were performed to evaluate the monotonicity of the gradients using Kaplan‐Meier estimation and the log‐rank test.RESULTS.The 5‐year survival rate for the entire cohort was 13.6%. The independent predictors of survival were serum albumin level (≤3.4 g/dL), the presence of ascites, serum α‐fetoprotein level (>60 ng/mL), and portal or hepatic vein tumor thrombosis (P = .001, P = .001, P = .004, and P = .000, respectively). The Cancer of the Liver Italian Program classification system was superior to the other 6 prognostic systems regarding discriminatory ability and the monotonicity of the gradients.CONCLUSIONS.In this comparison of many staging systems, the Cancer of Liver Italian Program system provided the best prognostic stratification for a cohort the patients with hepatocellular carcinoma who underwent transarterial chemoembolization. Cancer 2008. © 2007 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Comparison of 7 staging systems for patients with hepatocellular carcinoma undergoing transarterial chemoembolization

Cho

Chung

Kim

et al. 2007

Cancer

110

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“…8,21,23 Higher risk of vascular invasion and higher tumor grade may occur in larger tumors, especially those larger than 5 cm. [13][14][15] Relatively, multiple tumors in both lobes with size less than 5 cm may have lower risk of occult vascular invasion and intrahepatic metastasis. Additionally, survival rates were better after treatment in these patients.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have identified that tumor size and pathological grade are correlated with microvascular invasion. [13][14][15] The risk of vascular invasion and poor prognosis that can be predicted increases with tumor size.…”

mentioning

confidence: 99%

Validation of clinical AJCC/UICC TNM staging system for hepatocellular carcinoma: Analysis of 5,613 cases from a medical center in southern Taiwan

Kee

Wang

Lee

et al. 2007

Intl Journal of Cancer

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This study was aimed to validate the 5th and 6th editions of tumor-node-metastasis (TNM) system for patients with hepatocellular carcinoma (HCC), and attempted to improve prognostic stratification by modifying the 6th edition according to vascular invasion and tumor size. From 1986 to 2002, a total of 5,613 HCC cases from Kaohsiung Chang Gung Memorial Hospital in southern Taiwan were enrolled. The 6th edition was modified by dividing stage I into stages IA (single tumor, £2cm) and IB (single tumor, >2cm), and by dividing stage II into IIA (multiple tumors, none >5cm) and IIB (tumor with segmental macro vascular invasion). The Akaike information criteria (AIC), within a Cox proportional hazard regression model were used; lower AIC value indicated a better discriminatory ability for staging system. The 1-, 3-, 5-, and 7-year overall survival rates were 45.6, 25.9, 17.9, and 13.4%, respectively. Significant differences in survival curve existed in the 5th, 6th, and modified 6th edition TNM systems. For the modified 6th edition TNM, survival differed significantly between stages IA and IB, and between stage IIA and IIB. The AIC values of 5th (72,328), 6th (72,188), modified 6th (71,991) edition TNM system were decreasing. This investigation demonstrated better prognostic stratifications for the 6th edition than the 5th edition TNM staging system. Moreover, the modified 6th edition staging system demonstrated better prognostic prediction than the former two. Pretreatment staging and simple classification of current modified 6th edition TNM staging can be applied to all HCC patients and are clinically useful. ' 2007 Wiley-Liss, Inc.

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“…129 Vascular invasion is valued as an early indicator of the aggressiveness of a tumour (for example, its metastatic potential or the likelihood of rapid recurrence following treatment). 130 Rates of vascular invasion are significantly lower in tumours that are small, 131 histologically well differentiated 132 or encapsulated. 129 It has also been found that tumours arising in women are more likely to be encapsulated 133 and less likely to show vascular invasion.…”

Section: Pathologymentioning

confidence: 99%

Surveillance of cirrhosis for hepatocellular carcinoma: systematic review and economic analysis

Coon¹,

Rogers²,

Hewson³

et al. 2007

Health Technol Assess

151

108

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Clinical significance of microscopic tumor venous invasion in patients with resectable hepatocellular carcinoma

Cited by 250 publications

References 16 publications

Comparison of 7 staging systems for patients with hepatocellular carcinoma undergoing transarterial chemoembolization

Comparison of 7 staging systems for patients with hepatocellular carcinoma undergoing transarterial chemoembolization

Validation of clinical AJCC/UICC TNM staging system for hepatocellular carcinoma: Analysis of 5,613 cases from a medical center in southern Taiwan

Surveillance of cirrhosis for hepatocellular carcinoma: systematic review and economic analysis

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