Patterns, Risk Factors, and Outcomes of Recurrence After Hepatectomy for Hepatocellular Carcinoma with and without Microvascular Invasion

Yang Yu,1,&ast; Xiao-Hui Wang,2,&ast; Wen-Jie Hu,1 De-Hua Chen,1 Zi-Li Hu,3 Shao-Qiang Li1 1Hepatic Pancreatobiliary Surgery Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, People’s Republic of China; 2Department of Hepatobiliary Surgery, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University) Changsha, Hunan Province, 410005, People’s Republic of China; 3Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangdong, 510060, Guangzhou, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Shao-Qiang Li, Hepatic Pancreatobiliary Surgery Center, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, People’s Republic of China, Tel +86-020-87755766-8214, Fax +86-020-87755766-8661, Email lishaoq@mail.sysu.edu.cnPurpose: The patterns and risk factors of postsurgical recurrence of patient with hepatocellular carcinoma (HCC) with microvascular invasion (MVI) are not clarified. This study aimed to decipher and compare the postoperative recurrent patterns and the risk factors contributing to recurrence between MVI positive (MVI(+)) and MVI negative (MVI(-)) HCC after hepatectomy.Patients and methods: Patients with HCC who underwent hepatectomy in three Chinese academic hospitals between January 1, 2009, and December 31, 2018, were enrolled. Recurrent patterns included early (≤ 2 years) or late (> 2 years) recurrence, recurrent sites and number, and risk factors of recurrence were compared between the MVI(+)and MVI(-) groups by propensity score–matching (PSM).Results: Of 1756 patients included, 581 (33.1%) were MVI(+), and 875 (49.8%) patients developed early recurrence. Compared with the MVI(-) group, the MVI(+) group had a higher 2-year recurrence rate in the PSM cohort (hazard ratio [HR], 1.82; 95% confidence interval [CI], 1.59– 2.10; P < 0.001), and more patients with multiple tumor recurrence. Patients with early recurrence in the MVI(+) group had a worse overall survival (OS) than those in the MVI(-) group (HR, 1.24; 95% CI, 1.02– 1.50; P = 0.034). Resection margin (RM) ≤ 1.0 cm is a surgical predictor of early recurrence for the MVI(+) group (HR, 0.68; 95% CI, 0.54– 0.87; P = 0.002), but not for the MVI(-) group.Conclusion: Compared to MVI(-) HCC, MVI(+) HCC tends to be early, multiple recurrence and lung and lymph node metastasis after resection. RM ≤ 1.0 cm is a surgical risk factor of early recurrence for patient with MVI.Keywords: hepatocellular carcinoma, microvascular invasion, recurrence patterns, risk factors, outcomes