Clinical significance of intracapsular and extratumoral venous invasion in hepatocellular carcinoma.

Background/aims: The current study sought to clarify whether intracapsular venous invasion and extratumoral venous invasion confer different prognostic significance in patients undergoing hepatectomy for hepatocellular carcinoma.

Methodology: A retrospective study of 275 consecutive patients who underwent hepatectomy for hepatocellular carcinoma was conducted. Extratumoral venous invasion was defined as gross or microscopic involvement of vessels within the peritumoral liver tissue, whereas intracapsular venous invasion was defined as microscopic involvement of vessels within the fibrous tumor capsule. The median follow-up time was 64 months.

Results: Vascular invasion was found in 104 (38%) of the 275 patients. Intracapsular venous invasion was present in 16 patients and extratumoral venous invasion observed in 88 patients. Overall cumulative survival rates were 64% at 5 years and 45% at 10 years. Vascular invasion was a strong prognostic factor by univariate (p = 0.0001) and multivariate (p = 0.006) analyses. Survival after hepatectomy was significantly worse in patients with extratumoral venous invasion (cumulative 10-year survival rate of 28%) than in patients with intracapsular venous invasion (cumulative 10-year survival rate of 70%; p = 0.0082).

Conclusions: Extratumoral venous invasion adversely influences survival after hepatectomy for hepatocellular carcinoma compared to intracapsular venous invasion.