Clinical predictors of small solitary hepatitis B virus-related hepatocellular carcinoma microinvasion.
BACKGROUND
Microinvasion serves as a reliable indicator of poor prognosis after hepatectomy or transplantation for hepatocellular carcinoma (HCC). However, microinvasion is difficult to detect with current imaging modalities and is usually diagnosed histopathologically. The aim of this study is to identify the preoperative clinical predictors of microinvasion of small solitary hepatitis B virus (HBV)-related HCC.


METHODS
From January 2000 to December 2009, 110 patients with HBV-related small primary solitary HCC (tumour diameter ≤3.0 cm) who underwent hepatectomy at Chinese PLA General Hospital were enrolled. The independent predictors of microinvasion, such as microvascular invasion and microscopic satellite nodules, were analysed. The prognosis of patients with microinvasion was compared with that of patients without microinvasion.


RESULTS
Of the 110 patients, 31 (28.2%) exhibited microinvasion. Among them, 16 (51.6%) had microvascular invasion with microscopic satellite nodules, five (16.1%) had microscopic satellite nodules without microvascular invasion and 10 (32.3%) had microvascular invasion without microscopic satellite nodules. Two independent predictors of microinvasion were identified: serum alpha-fetoprotein >20 ng/mL and a viral load of >104 copies/mL. Patients without microinvasion exhibited a significantly better prognostic outcome compared with those with microinvasion.


CONCLUSION
Regarding HBV-related small HCC, patients presenting with alpha-fetoprotein levels >20 ng/mL and a high viral load (HBV-DNA >104 copies/mL) are at substantial risk for microinvasion.
['Lu|Wenping|W|0000-0002-9157-272X', 'Tang|Haowen|H|', 'Yang|Zhanyu|Z|', 'Jiang|Kai|K|', 'Chen|Yongliang|Y|', 'Lu|Shichun|S|']
D000328:Adult D000368:Aged D006528:Carcinoma, Hepatocellular D015331:Cohort Studies D005260:Female D006498:Hepatectomy D006515:Hepatitis B virus D006801:Humans D008113:Liver Neoplasms D008297:Male D008875:Middle Aged D009361:Neoplasm Invasiveness D012307:Risk Factors D019562:Viral Load D055815:Young Adult D000509:alpha-Fetoproteins
hepatocellular carcinoma microinvasion prognosis hepatitis B virus alpha-fetoprotein viral load