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J Gastroenterol Hepatol. 2009 Aug;24(8):1431-6. doi: 10.1111/j.1440-1746.2009.05847.x. Epub 2009 Apr 13.

Predictors of microscopic portal vein invasion by hepatocellular carcinoma: measurement of portal perfusion defect area ratio.

Author information

1
Department of Hepatogastroenterological Surgery, Aso Iizuka Hospital, Iizuka City, Honshu, Japan. kshirabeh1@aih-net.com

Abstract

OBJECTIVE:

Microscopic portal vein invasion (PVI) by cancer cells is a poor prognostic factor after hepatic resection for hepatocellular carcinoma (HCC). The aim of this study is to predict PVI preoperatively in patients with HCC.

METHODS:

We studied 46 hepatectomized patients who had HCC without any portal venous invasion detected during preoperative radiographic evaluation. We defined the portal perfusion defect area ratio (PPDAR) as the following: the quotient of the maximal portal perfusion defect area, on computed tomography during arterio-portography (CTAP) is divided by the maximal tumor area on magnetic resonance imaging (MRI) or CT.

RESULTS:

The median PPDAR was 1.3 (mean 1.4 +/- 1.1; ranged from 0.7 to 5.8). The incidence of PVI was 4.5% in patients with a PPDAR <1.3, 35.7% in those with a PPDAR of 1.3-1.6, 70% in those with a PPDAR > or = 1.6 (P = 0.0005). When analyzing the preoperative value of different cut-off points for the PPDAR, the lowest P-value by Fisher's exact test was achieved when the PPDAR threshold was 1.6 (P = 0.0012). The sensitivity was 58%, and specificity was 91% with this cut-off value. On univariate analyses, factors that significantly correlated with PVI were PPDAR (P = 0.0012), serum levels of des-gamma-carboxy prothrombin (P = 0.033), and tumor size (P = 0.0126). On multivariate analysis, PPDAR was the only significant independent predictor of PVI.

CONCLUSION:

Our study shows that PPDAR is a new concept, which is useful in predicting PVI and that a value > or = 1.6 is predictive of PVI.

[Indexed for MEDLINE]

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