Predictors of Micrometastases in Patients with Barcelona Clinic Liver Cancer Classification B Hepatocellular Carcinoma
Yonsei Medical Journal 2017³â 58±Ç 4È£ p.737 ~ p.742
¼¼®¿ø(Suh Suk-Won) - Chung-Ang University College of Medicine Department of Surgery
ÃÖÀ¯½Å(Choi Yoo-Shin) - Chung-Ang University College of Medicine Department of Surgery
Abstract
Purpose: Transarterial chemoembolization (TACE) is indicated for Barcelona Clinic Liver Cancer (BCLC) B hepatocellular carcinoma (HCC). Whether TACE provides any long-term survival benefits remains unclear. We aimed to investigate micrometastases predictors with which to identify patients who would benefit from surgical resection (SR).
Materials and Methods: First, we analyzed risk factors of micrometastases, microvascular invasion, and poor histologic grade in 38 patients with newly diagnosed resectable BCLC stage B HCC limited to one or two segments with well-preserved liver function and who underwent SR between January 2006 and December 2013. Second, we validated identified risk factors in 54 newly diagnosed resectable BCLC B HCC patients with well-preserved liver function who underwent TACE during the same period to determine their influence on survival.
Results: Risk factors of micrometastases in SR patients were ¥á-fetoprotein (AFP) ¡Ã110 [hazard ratio (HR)=5.166; 95% confidence interval (CI), 1.031?25.897; p=0.046] and prothrombin induced by vitamin K absence-II (PIVKA-II) ¡Ã800 (HR=5.166; 95% CI, 1.031?25.897; p=0.046). The cumulative probability of tumor recurrence (p=0.009) after SR differed according to levels of AFP and PIVKA-II. After validation of these risk factors in the TACE group, patients with SR and AFP <110 and PIVKA-II <800 had superior survival outcomes than other patients (HR=0.116; 95% CI, 0.027?0.497; p=0.004).
Conclusion: AFP and PIVKA-II levels predict micrometastases and survival. Therefore, they should be considered when selecting SR for BCLC B HCC.
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Predictors, micrometastases, Barcelona Clinic Liver Cancer classification B hepatocellular carcinoma, surgical resection, transarterial chemoembolization
KMID :
0311120170580040737
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À¯È¿¼º°á°ú(Recomendation)
Serum levels of AFP and PIVKA-II are useful predictors of tumor aggressiveness and micrometastasis in BCLC B HCC.