Related Factors And Prognosis Of Hepatocellular Carcinoma Patients With Microvascular Invasion

Objective:Study the incidence and characteristics of microvascular invasion in hepatocellular carcinoma and investigate the risk factors of microvascular invasion in hepatocellular carcinoma and the effect of recurrence-free survival after surgery,and to explore the effect of different types of microvascular invasion on prognosis and its clinical significance.And further summarize the progress of research related to microvascular invasion.To further understand the guiding significance of microvascular invasion for clinical treatment of patients with hepatocellular carcinoma.Methods:The clinical data of 201 patients with hepatocellular carcinoma who underwent radical hepatectomy in the same treatment group of the Department of Hepatobiliary Surgery of the Southern Hospital of Southern Medical University from November 2010 to March 2017 were collected and closely followed up to record the RFS time.According to the results of HE staining of hepatocellular carcinoma（HCC）and adjacent tissues,Pearson chi-square test was used to analyze the risk factors associated with MVI in liver cancer patients.Risk factors for postoperative recurrence of liver cancer were analyzed by multivariate Cox regression model.Kaplan-Meier method was used to analyze the effect of MVI on RFS time.Finally,according to the location of the MVI,it is divided into 3 types:MO type:no MVI is found in cancer tissues and adjacent tissues;M1 type:MVI in liver cancer tissues and no MVI in adjacent tissues;M2 type:a MVI in adjacent cancer tissues,regardless of whether there is a MVI in the cancer tissue;Kaplan-Meier method is used to compare the RFS time of different types of MVI patients.Results:In 201 patients with HCC,the incidence of MVI was 48.8%through the result of HE staining of cancer and adjacent tissues.The incidence rate was 47.8%in cancer tissues and 25.4%in adjacent tissues.Cancer tissues and adjacent tissues were detected in 49 cases with MVI.47 cases were detected in cancer tissues only,and 2 cases were detected in adjacent tissues only.47 cases（about 67.1%）with MVI were found in patients with HBV DNA≥2000 IU/ml,and 51 cases（about 38.9%）were positive in HBV DNA quantification<2000 IU/ml;There were 60 cases（about 87.7%）with MVI when AFP≥400 ng/ml,38 cases（about 29.0%）with MVI found in AFP<400ng/ml;When tumor diameter（D）≤3cm,35cm,the incidence of MVI was 36.1%,41.8%,and 58.2%,respectively.40 cases（about 87.0%）of MVI in the poorly differentiated tumor group,60 cases（about 49.2%）in the median differentiated group,and 5 cases（about 15.1%）in the highly differentiated group.In the BCLC stage A,B,and C,the incidence of MVI was 32.5%,40.7%,and 88.9%,respectively.In 124 tissues of TNM stage Ⅰ+Ⅱ,37 cases（about 29.8%）of MVI were found.In the tissues of stage Ⅲ+Ⅳ,61 cases（78.2%）of MVI were found.Univariate analysis of risk factors associated with microvascular invasion showed tumor diameter（<5cm/≥5cm）;AFP（<400/≥400ng/mL）;degree of differentiation;HBV quantification（<2000/≥2000 IU/ml）is a relevant factor for the occurrence of microvascular invasion in hepatocellular carcinoma.Cox regression analysis of RFS after radical hepatectomy in patients with hepatocellular carcinoma showed tumor diameter,tumor number,serum AFP values,MVI were independent risk factors for postoperative recurrence of liver cancer patients;The RFS of patients with hepatocellular carcinoma in the MVI positive group（MVI+）and the negative group（MVI-）.The prognosis of the MVI+group was worse than that of the MVI-group.The tumor-free survival rates of the MVI+ group at 1 2,3,and 5 years were 49.1%,37.9%,34.8%,and 23.3%,respectively.According to the MVI classification of our research,RFS time of patients with M0,M1,M2 type of MVI was respectively analyzed.The results suggest that the median survival time of M2 patients is about 8 months,M1 patients had a median survival time of about 17 months after surgery,while M3 patients had a better prognosis.The median survival time after surgery was about 33 months.Conclusion:HCC patients often have MVI（about 48.8%）,and small HCC patients also have MVI（about 36.1%）,which may lead to poor prognosis.Tumor diameter,preoperative AFP levels,HBV DNA quantification,BCLC staging and TNM staging are risk factors for the development of MVI.In this study,the survival prognosis of M2 patients was significantly worse,suggesting that the paracancerous MVI has a more important guiding significance for the prognosis of patients with hepatocellular carcinoma.Therefore,we should pay more attention to the detection of adjacent cancerous MVI.Some patients should advocate more active clinical monitoring follow-up and postoperative adjuvant therapy for clinicians.