PROPOSAL OF INVASIVENESS SCORE TO PREDICT RECURRENCE AND SURVIVAL AFTER CURATIVE HEPATIC RESECTION FOR HEPATOCELLULAR-CARCINOMA

Background. Hepatocellular carcinoma (HCC) is one of the most malignan t human tumors and is associated with a high incidence of postoperativ e recurrence. There is no generally accepted definition for HCC invasi veness. Moreover, the predictive value of the pathologic factors that reflect HCC invasiveness was previously studied as separate events, wi th much controversy among different study groups. in this study, we pr oposed an invasiveness scoring system based on the relative importance of six criteria for HCC invasiveness: portal vein invasion, intrahepa tic metastasis, hepatic vein invasion, serosal invasion, absence of tu mor capsule, or presence of capsular invasion. Methods. A total of 137 patients (111 male and 26 female) who underwent curative hepatectomy for HCC were included. Scoring of the six pathologic parameters was ba sed on the clinical significance of each parameter as a single predict or for recurrence after curative resection. According to our scoring s ystem, the patients were divided into three groups: low invasive HCC g roup A with a total invasiveness score 0 to 1, moderately invasive gro up B with a score of 2 to 4, and highly invasive group C with a total score of 5 or greater (5 to 11 points). Results. Evaluation of the cur rent scoring system showed a significant stepwise increase in the inci dence of recurrence as the invasiveness score increased. Moreover, dis ease-free survival was significantly different among the three groups (log rank p < 0.0001). The 1-, 3-, 5-, and 8-year disease-free surviva l rates were 89%, 59%, 54%, and 54% in group A; 72%, 32%, 12%, and 10% in group B; and 54%, 19%, 7%, and 0 in group C, respectively. Multiva riate analysis showed that the patients of groups B and C had a signif icantly worse prognosis compared with those of group A (p < 0.0001). C onclusions. The current scoring system can classify HCCs into three in vasive categories and predict more accurately recurrence and disease-f ree survival after curative hepatectomy compared with any single invas ive parameter previously proposed. Moreover, this system can be used a s a therapeutic guide during and after the surgical decision making.