肝细胞癌切除术后早期肝内复发的危险因素及对预后的影响

目的 探讨肝细胞癌(hepatoeellular carcinoma,HCC)切除术后早期肝内复发的预测因素及复发对预后的影响.方法 收集184例HCC患者切除术后肝内复发病例的临床病理资料,回顾性分析可能与早期肝内复发有关的13项临床病理学因素以及复发时间对HCC患者复发后生存期的影响.结果 单因素分析表明术前血清AFP>100 ng/ml(P=0.009)、肿瘤直径>5 cm(P<0.001)、血管浸润(P=0.001)以及术中输血(P=0.025)与HCC切除术后早期肝内复发有关;白蛋白<35S/L(P=0.083)可能与术后早期肝内复发有关.多因素分析表明 AFP>100 ng/ml(P=0.015)、肿瘤>5 cm(P=0.001)、微血管浸润(P=0.004)是与HCC切除术后早期肝内复发的独立的预测因素.早期肝内复发组复发后中位生存期(12个月)明显低于晚期复发组(18个月)(P=0.012).结论 术前AFP、肿瘤大小和血管浸润是HCC术后早期肝内复发的预测因素.HCC术后早期肝内复发病例预后不良.     

肝细胞癌切除术后早期肝内复发的危险因素及对预后的影响

目的 探讨肝细胞癌(hepatoeellular carcinoma,HCC)切除术后早期肝内复发的预测因素及复发对预后的影响.方法 收集184例HCC患者切除术后肝内复发病例的临床病理资料,回顾性分析可能与早期肝内复发有关的13项临床病理学因素以及复发时间对HCC患者复发后生存期的影响.结果 单因素分析表明术前血清AFP>100 ng/ml(P=0.009)、肿瘤直径>5 cm(P<0.001)、血管浸润(P=0.001)以及术中输血(P=0.025)与HCC切除术后早期肝内复发有关;白蛋白<35S/L(P=0.083)可能与术后早期肝内复发有关.多因素分析表明 AFP>100 ng/ml(P=0.015)、肿瘤>5 cm(P=0.001)、微血管浸润(P=0.004)是与HCC切除术后早期肝内复发的独立的预测因素.早期肝内复发组复发后中位生存期(12个月)明显低于晚期复发组(18个月)(P=0.012).结论 术前AFP、肿瘤大小和血管浸润是HCC术后早期肝内复发的预测因素.HCC术后早期肝内复发病例预后不良.     

原发性肝细胞癌根治性切除术后肝外复发的危险因素分析

目的 探讨影响原发性肝细胞癌(hepatocelluar carcinoma,HCC)根治性切除术后肝外复发的危险因素.方法 回顾性分析行根治性切除的238例HCC患者的临床资料,确定影响术后肝外复发的危险因素.结果 本组患者随访7-78个月,随访中位时间为34个月,32例(13.4%)出现肝外复发.依据单因素分析结果,术前血清甲胎蛋白(α fetoprotein,AFP)>1000 ng/ml、天冬氨酸氨基转移酶>50 IU/L、肝静脉侵犯、周围脏器侵犯、子灶、肿瘤包膜缺失是HCC根治性切除术后肝外复发的危险因素.多因素分析显示血清AFP>1000 ng/ml、肝静脉侵犯、周围脏器侵犯是肝外复发的独立危险因素.结论 HCC根治性切除术后肝外复发与术前血清AFP>1000 ng/ml、肝静脉侵犯、周围脏器侵犯有关.对具有这些危险因素的患者术后应加强随访.     

原发性肝癌患者手术切除术后早期复发影响因素分析

目的:探讨原发性肝癌(HCC)患者手术切除后早期复发的影响因素。方法:回顾性分析郑州大学第一附属医院2014年1月—2016年1月期间450例经手术切除的HCC患者的临床与随访资料,通过统计学方法分析HCC术后早期复发的影响因素。结果:450例患者中,2年内复发182例(40.4%)。单因素分析结果显示,HCC术后复发与门脉癌栓、术前血清AFP水平、肿瘤数目、最大直径、肿瘤分化程度有关(均P0.05);Cox比例风险回归分析显示,肿瘤数目(RR=2.148,95%CI=1.175～3.924,P=0.013),肿瘤最大直径(RR=1.591,95%CI=1.006～2.518,P=0.047),门脉有无癌栓(RR=1.835,95%CI=1.242～2.709,P=0.001),血清AFP水平(RR=1.722,95%CI=1.141～2.601,P=0.010),肿瘤分化程度(RR=1.463,95%CI=1.071～1.998,P=0.017)均是HCC术后复发的独立因素。通过以上因素建立函数模型对预测HCC术后早期复发的风险程度有一定价值(似然比检验:χ~2=45.727,P0.001)。结论:HCC患者手术切除术后早期复发的影响因素较多,其中门脉癌栓、肿瘤数目、最大直径、肿瘤分化程度、血清AFP水平可能是造成复发的独立危险因素,术前综合评估这些因素对预防术后复发有一定的指导意义。     

528例原发性肝细胞癌患者肝切除术后1年生存分析

目的 探讨原发性肝细胞癌患者( hepatocellular carcinoma,HCC)肝切除术后1年生存状况及影响因素.方法 回顾性分析1997年1月至2008年12月因HCC行肝切除的528例患者术后1年生存结果和影响因素.结果 本组患者随访期间死亡302例,患者1年累积生存率为84％.1年内死亡原因主要为HCC复发转移(78.1％,75/96)及与原发的肝病相关合并症(19.8％,19/96).大肝癌(P =0.047)、血管癌栓(P=1.118)、组织学中低分化(P =0.001)和病理切缘肿瘤残留(P=0.004)者是HCC患者1年内HCC复发转移死亡的独立危险因素;伴有门静脉高压症(P =0.001)是预示术后肝病相关死亡的独立因素.非RO切除的患者是1年内死亡(占59.3％)最重要的因素.结论 影响HCC切除术后1年生存的主要因素是HCC复发转移与原发的肝病相关因素,非R0切除是导致原发性HCC患者术后早期复发死亡的最主要的因素,术前伴有门静脉高压症是影响HCC患者术后肝病相关死亡的独立危险因素.     

中晚期原发性肝癌患者TACE术后早期复发危险因素

目的观察中晚期原发性肝癌(HCC)患者TACE术后早期复发危险因素。方法对42例中晚期原发性HCC患者行TACE治疗,术后随访6个月,对比分析早期复发与未复发患者之间的差异。结果术后6个月中,23例HCC早期复发(复发组),19例未复发(无复发组)。复发组白蛋白35 g/L者占比低于未复发组(P0.05),甲胎蛋白(AFP)400 ng/ml者占比及谷氨酰基转移酶(ALT)水平均高于未复发组(P均0.05)。未复发组肿瘤病理分化程度较高(P0.05),复发组瘤灶相对较多、肿瘤最大径较大,ADC值和包膜完整比例低于未复发组(P均0.05)。多因素Logistic回归分析结果显示,AFP400 ng/ml者占比(OR=3.313,P=0.041)、肿瘤分化程度(OR=1.463,P=0.038)、瘤灶数量(OR=2.216,P=0.028)及肿瘤ADC值(OR=0.025,P=0.003)是TACE术后HCC早期复发的独立危险因素。结论 TACE术后中晚期HCC早期复发与AFP、肿瘤分化程度、瘤灶数量及ADC值独立相关。     

原发性肝细胞癌行根治性肝切除术后复发的预后因素分析

目的 探讨原发性肝细胞癌(hepatocellular carcinoma,HCC)行根治性肝切除术后影响复发的预后因素.方法 回顾性分析2002年1月至2009年1月间行根治性肝切除术治疗的101例HCC患者的临床资料.应用Cox比例风险模型行单因素和多因素分析.Kaplan-Meier法计算术后复发时间,做Log-rank检验.应用受试者工作特征曲线评估预后因素预测能力,并做风险等级划分.结果 至随访截止,75例出现术后复发.早期复发(≤2年)63例(84.0%),晚期复发(＞2年)12例(16.0%).总体1、2、3、5年累积复发率分别为48.5%(49/101)、62.4%(63/101)、70.3%(71/101)、74.3%(75/101).多因素分析显示切缘肿瘤细胞阳性、巴塞罗那肝癌中心(BCLC)分级和肝硬化程度是HCC术后早期复发的影响因素,不同风险等级术后早期复发率的差异有统计学意义(χ2=29.198,P:0.000).年龄≥60岁和肿瘤包膜形成是HCC术后晚期复发的影响因素,不同风险等级术后晚期复发率的差异有统计学意义(χ2=8.479,P=0.004).结论 HCC行根治性肝切除术后早期复发和晚期复发的影响因素不同.切缘肿瘤细胞阳性、BCLC分级和肝硬化程度影响术后早期复发,而年龄≥60岁和肿瘤包膜形成是术后晚期复发的影响因素.预后因素等级划分有助于预测HCC患者术后复发.     

伴有肝硬化门静脉高压症的肝细胞癌患者肝切除术的并发症和预后分析

目的 探讨伴有门静脉高压症(portal hypertension,PH)的肝硬化相关的原发性肝细胞癌(hepatocellular carcinoma,HCC)患者R0切除的并发症及预后.方法 回顾性分析青岛大学医学院附属医院2001年1月至2010年12月获R0切除的肝硬化相关原发性HCC患者523例的临床资料、术后并发症和死亡率和随访结果.结果 523例患者中有146例(27.9％)伴有PH(PH组),377例无PH的证据(72.1％,无PT组);二组的术前资料对比分析显示,PH组患者术前TACE治疗、Child-PughB级、血清白蛋白值＜35g/L、输血和肿瘤直径≤5 cm者显著多于无PH组(P＜0.05).PH组和无PH组患者的手术死亡率为3.4％(死因均为肝病相关)和0.5％(x2=6.676,P=0.010),术后并发症的发生率分别为28.1％和14.3％ (P =0.001),PH组主要是肝病相关并发症(腹水＞800 ml/d、肝功能不全和肝衰竭)高.去除手术死亡的517例患者中,PH组和无PH组患者获R0切除术后的5年生存率分别为46.8％和54.6％ (P =0.047),无瘤生存率分别为37.0％和38.0％(P=0.725);Kaplan-Meier分析显示伴有PH、AFP≥20 ng/ml、肿瘤直径＞5 cm、非孤立型HCC、肝切除范围超过1个肝段和输血的患者其生存率显著降低(P＜0.05);Cox回归分析显示肿瘤直径＞5 cm和非孤立型HCC是影响肝硬化背景HCC患者R0切除术后的独立危险因素(P＜0.05).结论 伴有门静脉高压症的HCC患者R0切除术后的并发症和手术死亡率显著高于无PH的患者,肝病相关并发症是主要因素.虽然PH组HCC患者R0切除术后的生存时间显著低于无PH组,但伴有PH不是影响HCC患者R0切除术后长期生存的独立危险因素.     

肝癌肝移植术后复发的危险因素分析

目的探讨原发性肝癌(HCC)肝移植术后肿瘤复发或转移的危险因素。方法回顾性我院2003年4月至2007年11月期间76例HCC患者行肝移植的临床资料,根据随访期间是否有复发分为复发组(n=23)和未复发组(n=53),总结肿瘤复发的特点。结果 76例患者中23例(30.3%)术后复发。单因素分析显示患者性别(P=0.449)、年龄(P=0.091)、术前是否治疗(P=0.958)、肿瘤数目(P=0.212)和是否伴有HBV/HCV感染(P=0.220)与肿瘤的复发无关,而肿瘤包膜完整性(P=0.009)、肿瘤分期(P=0.002)、肿瘤直径(P<0.001)、血管侵犯(P<0.001)以及术前AFP水平(P=0.044)与肿瘤的复发有关,其中肿瘤直径<5.0 cm(P=0.001)和术后2个月AFP水平恢复正常者(P<0.001)1年复发率更低。多因素分析显示肿瘤直径(P=0.001,OR=6.456,95%CI为2.356～17.680)、血管侵犯(P=0.030,OR=10.653,95%CI为1.248～90.910)以及术前AFP水平(P=0.017,OR=2.601,95%CI为2.196～5.658)是肝移植术后肿瘤复发的独立危险因素。结论对于肿瘤直径>5.0 cm、伴有血管侵犯以及术前AFP水平≥400μg/L尤其术后2个月AFP水平仍高于正常者术后需加强监测,必要时尽早给予抗肿瘤治疗。     

改良BCLC分期预测原发性肝细胞癌行根治性肝切除术后早期肝内复发

目的 探讨改良BCLC分期对原发性肝细胞癌(hepatocellular carcinoma,HCC)根治性肝切除术后早期肝内复发的预测能力.方法 对我院2008年1月至2011年1月采用根治性肝切除术治疗的197例HCC临床资料进行回顾性分析.COX比例风险模型行术后早期复发的单因素和多因素分析.ROC曲线确定连续变量截点值和评估改良BCLC分期预测能力.结果 至随访截止,出现HCC术后早期肝内复发111例.术后6个月、9个月、12个月、18个月和24个月年累积复发率分别为26.9％(53/197)、37.6％(74/197)、45.2％(89/197)、53.8％(106/197)和56.3％ (111/197).多因素分析显示肝硬化程度、AFP≥185.6μg/L和BCLC分期是术后早期复发的影响因素.改良BCLC分期(modified BCLC staging system,M-BCLC)与BCLC分期预测术后6个月内复发的能力差异无统计学意义(P=0.652),但预测术后9、12、18和24个月内复发的能力优于BCLC分期(P值分别为0.030、0.001、0.015、0.008).ROC曲线截点值为M-BCLC≥2.913时,预测术后6个月内复发灵敏度83.0％,特异度51.9％;M-BCLC值≥3.098时,预测术后9个月内复发灵敏度71.6％,特异度67.0％;M-BCLC评分值≥2.727时,预测术后12个月内复发灵敏度84.3％,特异度64.4％;M-BCLC值≥2.727时,预测术后18个月内复发灵敏度80.2％,特异度58.4％;M-BCLC值≥2.555时,预测术后24个月内复发灵敏度82.7％,特异度75.6％.不同风险等级术后6-、9-、12-、18-和24个月内复发率分别为:低风险:12.3％(9/73)、15.1％(11/73)、17.8％(13/73)、24.7％(18/73)和26.0％(19/73);中等风险:18.2％(6/33)、30.3％ (10/33)、48.5％ (16/33)、60.0％(20/33)和63.6％(21/33);高风险:41.8％ (38/91)、58.2％ (53/91)、65.9％ (60/91)、74.7％ (68/91)和78.0％ (71/91)(Pearson x2检验P值均为＜0.001).不同风险等级术后中位早期复发时间差异明显(17.9个月、9.9个月比5.7个月,x2=25.770,P＜0.001,log秩检验).结论 与BCLC分期比较,M-BCLC提高了预测HCC根治性肝切除术后早期肝内复发的能力.     

Prognostic significance of anatomical resection and des-gamma-carboxy prothrombin in patients with hepatocellular carcinoma.

BACKGROUND: Portal venous tumour extension and intrahepatic metastasis result in a poor prognosis following hepatectomy for hepatocellular carcinoma (HCC). Anatomical resection is, in theory, preferable for eradicating these types of invasion. Des-gamma-carboxy prothrombin (DCP) has been reported to be associated with adverse pathological variables. This study investigated the significance of anatomical resection and DCP as predictive factors for postoperative recurrence of HCC. METHODS: A retrospective cohort study was carried out in 138 consecutive patients who underwent hepatectomy for HCC smaller than 5 cm using the Cox proportional hazards model. RESULTS: Eight factors were univariately related to poor prognosis (in decreasing order of hazard ratio): intrahepatic metastasis, multiple tumours, alpha-fetoprotein 32 ng/ml or more; DCP greater than 0.1 arbitrary units (AU), tumour-exposed surgical margin, vascular invasion, non-anatomical resection and tumour 2.5 cm or more. Three variables (DCP, vascular invasion and tumour-exposed surgical margin) were excluded by a stepwise procedure in multivariate analysis. Although DCP was not an independent prognostic factor, a model replacing intrahepatic metastasis with DCP showed similar predictive accuracy in a receiver-operating characteristic curve. CONCLUSION: Anatomical resection appeared to have a beneficial effect on recurrence-free survival after hepatectomy for HCC. DCP measurement was effective in predicting HCC recurrence and had the advantage that it can be assessed before operation.     

肝细胞癌根治性切除术后肝内复发的危险因素分析

目的探讨肝细胞癌根治性切除术后肝内复发的独立危险因素,为肝细胞癌的临床综合治疗提供依据。方法回顾性分析实施肝癌根治性切除的194例肝细胞癌患者的临床资料,将全部病例以术后复发时间2年为界,划分为2年内复发组和2年内未复发组,比较两组之间21项可能影响肝细胞癌术后肝内复发的临床指标的差异。结果单因素分析结果示：2年内复发组的术前血清AFP浓度〉20ng／ml、术前血清AST浓度〉40U／L、术前血清ALP浓度〉135U／L、术前血清GGT浓度〉50U／L、血清HBsAg测定为阳性、肿瘤最大直径〉5cm、肿瘤病灶数目为2个、手术持续时间≥180min、手术中总失血量≥1000ml、手术中有输血的病例数的构成比高于2年内未复发组,且差异有统计学意义。多因素分析结果显示术前血清ALP浓度、肿瘤最大直径、肿瘤病灶数目、手术中总失血量是影响肝细胞癌术后肝内复发的有统计学意义的因素。结论肝细胞癌术后肝内复发是多种因素的共同作用的结果,术前血清ALP浓度、肿瘤最大直径、肿瘤病灶数目、手术中总失血量是影响肝细胞癌术后肝内复发的独立的危险因素。     

Nomograms predicting extra- and early intrahepatic recurrence after hepatic resection of hepatocellular carcinoma

BackgroundExtrahepatic recurrence and early intrahepatic recurrence of hepatocellular carcinoma after hepatic resection are indicative of poor prognoses. We aimed to develop nomograms to predict extrahepatic recurrence and early intrahepatic recurrence after hepatic resection.MethodsThe participants of this study were 1,206 patients who underwent initial and curative hepatic resection for hepatocellular carcinoma. Multivariate logistic regression analyses using the Akaike information criterion were used to construct nomograms to predict extrahepatic recurrence and early intrahepatic recurrence (within 1 year of surgery) at the first recurrence sites after hepatic resection. Performance of each nomogram was evaluated by calibration plots with bootstrapping.ResultsExtrahepatic recurrence was identified in 95 patients (7.9%) and early intrahepatic recurrence in 296 patients (24.5%). Three predictive factors, α-fetoprotein >200 ng/mL, tumor size (3–5 cm or >5 cm vs ≤3 cm), and image-diagnosed venous invasion by computed tomography, were adopted in the final model of the extrahepatic recurrence nomogram with a concordance index of 0.75. Tumor size and 2 additional predictors (ie, multiple tumors and image-diagnosed portal invasion) were adopted in the final model of the early intrahepatic recurrence nomogram with a concordance index of 0.67. The calibration plots showed good agreement between the nomogram predictions of extrahepatic recurrence and early intrahepatic recurrence and the actual observations of extrahepatic recurrence and early intrahepatic recurrence, respectively.ConclusionWe have developed reliable nomograms to predict extrahepatic recurrence and early intrahepatic recurrence of hepatocellular carcinoma after hepatic resection. These are useful for the diagnostic prediction of extrahepatic recurrence and early intrahepatic recurrence and could guide the surgeon’s selection of treatment strategies for hepatocellular carcinoma patients.     

Predictors of hepatic venous trunk invasion and prognostic factors in patients with hepatocellular carcinomas that had come into contact with the trunk of major hepatic veins

PURPOSE: In this study, we tried to identify the preoperative predictors of hepatic venous trunk invasion and the prognostic factors in patients with hepatocellular carcinoma (HCC) that had come into contact with the trunk of a major hepatic vein over a distance of 1.0 cm or more. METHODS: Forty patients who had such HCCs resected were entered into this study and predictors of hepatic venous trunk invasion and prognostic factors were evaluated by univariate and multivariate analyses. RESULTS AND CONCLUSIONS: A combined resection of the HCC and the venous trunk was performed in 29 patients. Hepatic venous trunk invasion was observed in 12 patients, including 2 with inferior vena cava tumor thrombus. A stepwise logistic regression analysis indicated that tumors larger than or equal to 7 cm in diameter and tumors showing a poorly differentiated histological grade were independent predictors of hepatic venous trunk invasion. The survival of patients without venous trunk invasion was significantly better than that for patients with venous trunk invasion (P = 0.048). A univariate analysis revealed that Child-Pugh classification B (P = 0.002), a high des-gamma-carboxy prothrombin concentration (> or =400 mAU/ml, P = 0.023), a large HCC (> or =5.0 cm in diameter, P = 0.002), the presence of portal vein invasion (P < 0.001), the presence of venous trunk invasion (P = 0.048), the presence of intrahepatic metastasis (P < 0.001), and poorly differentiated HCC (P = 0.006) correlated with a worse overall survival after hepatic resection. In a multivariate analysis, however, only the presence of intrahepatic metastasis (P = 0.037, relative risk 8.25) was an independent predictor of poor overall survival. CONCLUSIONS: Large tumors (> or =7 cm in diameter) and poorly differentiated HCCs were more likely to be associated with hepatic venous trunk invasion and intrahepatic metastasis was an independent prognostic factor in patients with HCC that had come into contact with the trunk of a major hepatic vein.     

Predictor for Histological Microvascular Invasion of Hepatocellular Carcinoma: A Lesson from 229 Consecutive Cases of Curative Liver Resection

Background

Microscopic vascular invasion is an important risk factor for recurrent hepatocellular carcinoma (HCC), even after curative liver resection or orthotopic liver transplantation. To predict microscopic portal venous invasion, the following two questions were examined retrospectively: Is it possible to detect microvascular invasion preoperatively? What are the characteristics of a group of early HCC recurrences even with no microvascular invasion?

Methods

Study 1 included 229 patients with HCC who underwent curative liver resection between 1991 and 2008; 127 had HCC without microscopic portal venous invasion, and 52 had HCC with microscopic portal venous invasion (MPVI). These two distinct groups were analyzed with regard to various clinicopathologic factors. Subsequently, we specifically investigated if HCCs <5 cm with vascular invasion (n = 32) have some characteristics that would allow detection of latent microvascular invasion. Study 2 included 127 HCC patients without MVPI; 42 had a recurrence within 2 years, and 85 patients were recurrence-free for at least 2 years. These two distinct groups were analyzed with regard to various clinicopathologic factors.

Results

HCC diameter of >5 cm, the macroscopic appearance of HCC, and high levels of preoperative des-γ-carboxyprothrombin are significant prognostic factors in identifying microvascular invasion of HCC. The strongest predictor of early recurrence (within 2 years) was the serum α-fetoprotein level in patients without clear microvascular invasion.

Conclusions

Tumor size, macroscopic appearance, and high tumor marker levels are important elements in identifying the group of patients with a low HCC recurrence rate after curative liver resection.     

Liver fibrosis increases the risk of intrahepatic recurrence after hepatectomy for hepatocellular carcinoma

BACKGROUND: Hepatocellular carcinoma (HCC) commonly develops in patients with chronic hepatitis. Intrahepatic recurrence after hepatectomy often includes nodules of new tumour in the liver remnant. The aim of this study was to examine hepatitis-related factors that might predict this type of recurrence. METHODS: The influence of various hepatitis-related factors on intrahepatic recurrence of HCC was studied by multivariate analysis in 138 patients who underwent curative resection and were followed for more than 2 years. RESULTS: The Cox proportional hazard model showed that histological evidence of fibrosis of the underlying liver was the most significant predictive factor for intrahepatic recurrence (P = 0.001). Serum albumin level was also significantly associated with recurrence (P = 0.038). The relative risks of histological fibrosis and low serum albumin levels were 8.9 and 1.7 respectively. Among tumour-related factors, only tumour size was significantly associated with recurrence (P = 0.017). Major hepatectomy was also an independent risk factor for intrahepatic recurrence (P = 0.004). CONCLUSION: Histological evidence of fibrosis and low serum albumin levels are useful predictors of intrahepatic recurrence after hepatectomy, presumably owing to metachronous multifocal tumour in the liver remnant.     

Microvascular Invasion in Patients with Hepatocellular Carcinoma and Its Predictable Clinicopathological Factors

Background Macroscopic vascular invasion is known to be a poor prognostic factor in hepatocellular carcinoma (HCC). The aim of this study was to determine the outcomes and predictive factors after hepatic resection for HCC with microvascular invasion (MVI). Methods One hundred ten patients who underwent curative resection for HCC without macroscopic vascular invasion were included in this retrospective study. The risk factors of these patients for recurrence-free and disease-specific survival were investigated, and the clinicopathological factors predicting the presence of MVI were also determined. Results Of the 110 resected specimens, 49 (45%) had evidence of MVI. By univariate analysis, MVI was found to be statistically significantly associated with greater tumor size, gross classification, histological grade, and intrahepatic micrometastasis. Gross classification proved to be the only independent predictive factor for MVI by multiple logistic regression analysis. By multivariate analysis, cirrhosis and MVI were identified as independent risk factors for recurrence-free survival. The 5-year recurrence-free survival rates for patients with and without MVI were 20.8% and 52.6%, respectively. By multivariate analysis, the number of tumors, presence of MVI, and intrahepatic micrometastasis were identified as independent predictors of disease-specific survival. The 5-year disease-specific survival rates for patients with and without MVI were 59.3% and 92.0%, respectively. Conclusions The presence of MVI was the most important risk factor affecting recurrence and survival in HCC patients after curative resection. Furthermore, this study showed that gross classification of HCC can be very helpful in predicting the presence of MVI.