Microsatellite distribution and indication for locoregional therapy in small hepatocellular carcinoma

Abstract

BACKGROUND Intrahepatic disease recurrence is observed frequently after locoregional therapies for patients with hepatocellular carcinoma (HCC). However, the indication for locoregional therapy is still unclear. To clarify the indication for locoregional therapy for small HCC tumors, the authors measured the distance of microsatellites from the main tumor and analyzed the relation between this distance and clinicopathologic factors. METHODS The authors retrospectively analyzed 100 patients with small HCC tumors (≤ 5 cm in dimension) treated by curative hepatectomy. A microsatellite was defined as invasion into the portal vein or intrahepatic metastasis, and the distance from the main tumor to the most distant microsatellite was determined under light microscopy. The current study investigated the relation between microsatellite distance (0 mm if none present, ≤ 5 mm, and > 5 mm) and clinicopathologic factors, as well as overall and disease‐free survival rates after hepatectomy. RESULTS Of the 100 patients, 46 had microsatellites with a mean distance of 9.9 mm (median, 5.0 mm). Of the clinicopathologic factors investigated, tumor grade and preoperative α‐fetoprotein level significantly correlated with the presence of a microsatellite. Tumor size and distance to the microsatellite were significantly correlated. All but 1 tumor associated with a microsatellite distance > 5 mm was a high‐grade tumor > 25 mm in greatest dimension. The overall survival rate of patients with a microsatellite distance of > 5 mm was lower than that of patients with a microsatellite distance < 5 mm. CONCLUSIONS Locoregional therapy, including limited resection and ablation therapies, was appropriate for patients with low‐grade HCC tumors or with tumors < 25 mm in diameter. Cancer 2005. © 2004 American Cancer Society.

A review of clinical and histological parameters associated with contralateral neck metastases in oral squamous cell carcinoma

“…By the same rule, tumor satellite distance (TSD), which reflects the sprea-ding ability of tumor satellites and is regarded as a prognosticator in hepatocellular carcinoma initially, is defined as the distance from the main tumor to the most distant tumor satellite [85]. It has been demonstrated that TSD can also serve as a significant prognosticator of SCC in the oral cavity.…”

Three-Dimensional Measurement of Hepatocellular Carcinoma Ablation Zones and Margins for Predicting Local Tumor Progression

“…The likelihood of local progression increases with tumor size as a result of satellite nodules (8), which is why a 5-mm minimum ablation margin is recommended by several studies (9,10). However, some of these studies (9,11,12) used a rigid registration that is not optimal for the liver because of significant deformations by respiratory movements and the ablation zone (13).…”

Open Liver Resection, Laparoscopic Liver Resection, and Percutaneous Thermal Ablation for Patients with Solitary Small Hepatocellular Carcinoma (≤30 mm): Review of the Literature and Proposal for a Therapeutic Strategy

“…In larger tumors, other prognostic factors may mask the benefit from AR, while in very early HCC (< 2 cm), the risk for tumor spread along portal pedicles is limited. Pathology studies confirmed that microsatellites and thrombosis are extremely rare for very early HCC [34]. Second, superficial HCC are treated by non-AR even in centers regularly performing AR.…”

“…In the very early and early stage HCC, several randomized controlled trials demonstrated the superiority of RFA versus PEI, with complete response rates of 95–96% for RFA vs. 82–86% for PEI, 2-year local recurrence rates of 2–18 vs. 11–33%, and 3-year survival rates of 74–81 vs. 55–73% [72, 73]. This superiority has been mostly attributed to the capability of RFA to ablate a rim of perilesional non-tumoral tissue where microsatellite nodules are frequently located [34]. Nowadays, PEI has a very limited role for the treatment of tiny (≤10 mm) HCC, mostly located in anatomical areas at risk for ablation (adjacent to gallbladder, main bile ducts, or bowel loops).…”