Avaliação dos fatores preditores de invasão vascular microscópica no carcinoma hepatocelular

Abstract

Background: Microvascular invasion (MVI) is a well-known risk factor for hepatocellular carcinoma (HCC) recurrence and mortality after liver transplantation (LT). The aim of this study was to determine clinicopathological predictive factors associated with MVI. Methods: Records of all patients who underwent LT with HCC at Hospital das Clínicas da Universidade Federal de Minas Gerais, between July 2001 and December 2010, were reviewed. Laboratory tests, clinical and demographic data were obtained. Histopathological review of the hematoxylin and eosin specimens was performed by a single liver pathologist. Results: A total of 107 patients were included, 76 male (71%) and the mean age was 56.8 (±8.7). Tumor recurrence rate was 12.9%. One, three and five years overall survival was 75.0, 71.4 and 67.5% respectively. Only tumor recurrence was associated with mortality (p=0.038; OR= 2.54; CI 1.052 to 6.106). Mitotic index, histological grade, tumor architecture, alpha-fetoprotein and tumor fibrosis were included in the multivariate model. Significant independent predictors of MVI on logistic regression analysis were histological grade and mitotic index (p < 0.001; OR 3.16; CI 1.525 to 4.156 and p = 0.046; OR 2.56; CI 1.061 to 6.451 respectively). Discussion: Mitotic index and histological grade are good predictors of MVI. No other risk factor was identified in the logistic regression. These results highlight the importance of discussing pre transplantation liver biopsy to access prognosis and define treatment modalities in the setting of LT.