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Vascular Invasion in Hepatocellular Carcinoma: Prevalence, Determinants and Prognostic Impact

Lee, Yun-Hsuan MD*,†; Hsu, Chia-Yang MD*,†,‡; Huang, Yi-Hsiang MD, PhD†,§; Hsia, Cheng-Yuan MD*,∥; Chiou, Yi-You MD*,¶; Su, Chien-Wei MD*,†; Lin, Han-Chieh MD*,†; Huo, Teh-Ia MD*,†,#

Journal of Clinical Gastroenterology: September 2014 - Volume 48 - Issue 8 - p 734–741
doi: 10.1097/MCG.0b013e3182a8a254

Goals/Background: Macrovascular invasion (MaVI) is often detected by radiologic imaging in hepatocellular carcinoma (HCC) patients and may affect their long-term survival. We aimed to investigate the prevalence, determinants, and prognostic impact of MaVI in patients with HCC receiving curative and noncurative therapies.

Study: A total of 2654 HCC patients in a single center were identified. The risk factors and prognostic determinants of MaVI were determined.

Results: A total of 928 (35%) patients had MaVI. Old age, lower serum α-fetoprotein level, higher serum sodium level, good performance status, smaller total tumor volume, and better liver functional reserve were significantly associated with a lower risk for VI. In the Cox proportional hazards model, patients with lower serum albumin level, higher serum bilirubin and α-fetoprotein level, worse performance status, the presence of ascites, and MaVI independently predicted a decreased long-term survival in patients undergoing both curative and noncurative treatments. In addition, lower sodium level and larger tumor size were independently associated with a poor outcome in the noncurative treatment group. Of the patients with MaVI, the 1-year survival rates for patients receiving surgical treatment, local ablation, transarterial chemoembolization, and supportive care were 83%, 75%, 57%, and 24%, respectively (P<0.001).

Conclusions: MaVI represents a distinct tumor phenotype of HCC and is associated with younger age, aggressive tumor behavior, poor liver functional reserve, and poor performance status. It adversely affects the survival of HCC patients independent of treatment strategy. Intensive anticancer therapy should be proposed to achieve a better long-term survival for the at-risk patients.

*Faculty of Medicine

§Institute of Clinical Medicine

#Institute of Pharmacology, National Yang-Ming University School of Medicine, Taipei, Taiwan

Departments of Medicine


Radiology, Taipei Veterans General Hospital, Taipei, Taiwan

Department of Biostatistics, UCLA, Los Angeles, CA

The authors declare that they have nothing to disclose.

Supported by grants from the Center of Excellence for Cancer Research at Taipei Veterans General Hospital (DOH102-TD-C-111-007), Taipei, Taiwan; the Taipei Veterans General Hospital (V101C-170), Taipei, Taiwan; and the Ministry of Education, Aim for the Top University Plan (101AC-D101), Taiwan.

Reprints: Teh-Ia Huo, MD, Department of Medicine, Division of Gastroenterology, Taipei Veterans General Hospital, Taipei 112, Taiwan (e-mail:

Received May 6, 2013

Accepted July 29, 2013

© 2014 by Lippincott Williams & Wilkins