The guiding value of microvascular invasion for treating early recurrent small hepatocellular carcinoma

Hepatocellular carcinoma (HCC) patients with microvascular invasion (MVI) have worse survival. Whether the presence of MVI indicates the necessity of more aggressive locoregional treatments for recurrences remains to be elucidated. We reviewed patients who underwent curative hepatectomy for primary HCC in our institution, and 379 patients with recurrent HCC up to three nodules smaller than 3 cm were enrolled. The Kaplan–Meier method was adopted to compare the secondary recurrence-free survival (sRFS) and post-recurrence survival (PRS) among patients undergoing hepatectomy, RFA and transarterial chemoembolization plus RFA (TACE-RFA). Cox regression analyses were performed to identify independent prognostic factors. Both the sRFS and PRS of the MVI (−) group were significantly longer than those of the MVI (+) group (<i>p</i> = 0.001 and 0.011). For patients with MVI (−), no significant difference was found in sRFS or PRS among recurrent HCC patients receiving hepatectomy, RFA or TACE-RFA (<i>p</i> = 0.149 and 0.821). A similar trend was found in patients with MVI (+) (<i>p</i> = 0.851 and 0.960). Further analysis found that TACE-RFA provided better sRFS than hepatectomy or RFA alone in patients with MVI (+) and early recurrence within two years (<i>p</i> = 0.036 and 0.044). For HCC patients with MVI (+) and early small recurrence, TACE-RFA could achieve better prognosis than hepatectomy or RFA alone, while RFA alone provided comparable survival benefits compared with hepatectomy or TACE-RFA in other HCC patients with small recurrence.

伴有微血管侵犯（microvascular invasion, MVI）的肝细胞癌（Hepatocellular carcinoma, HCC）患者生存预后更差。微血管侵犯是否提示复发后需采取更积极的局部区域治疗，仍有待阐明。本研究回顾了本机构内接受原发性肝细胞癌根治性肝切除术的患者，最终纳入379例存在至多3个直径小于3cm复发性肝细胞癌病灶的患者。采用Kaplan–Meier法比较接受肝切除术、射频消融（radiofrequency ablation, RFA）以及经动脉化疗栓塞联合射频消融（transarterial chemoembolization plus RFA, TACE-RFA）治疗的患者的二次无复发生存期（secondary recurrence-free survival, sRFS）和复发后生存期（post-recurrence survival, PRS）；通过Cox回归分析识别独立预后因素。MVI阴性组患者的二次无复发生存期与复发后生存期均显著长于MVI阳性组（p=0.001和0.011）。对于MVI阴性患者，接受肝切除术、RFA或TACE-RFA治疗的复发性肝细胞癌患者的二次无复发生存期与复发后生存期均无显著差异（p=0.149和0.821）。MVI阳性患者亦呈现相似趋势（p=0.851和0.960）。进一步分析显示，在MVI阳性且2年内早期复发的患者中，TACE-RFA的二次无复发生存期优于单纯肝切除术或单纯RFA（p=0.036和0.044）。对于伴有MVI阳性且早期小体积复发的肝细胞癌患者，TACE-RFA可获得优于单纯肝切除术或单纯RFA的预后；而在其他存在小体积复发的肝细胞癌患者中，单纯RFA与肝切除术或TACE-RFA的生存获益相当。