Milan Criteria, Multi-nodularity, and Microvascular Invasion Predict the Recurrence Patterns of Hepatocellular Carcinoma After Resection

Hung Hsu Hung, Hao Jan Lei, Gar Yang Chau, Chien Wei Su, Cheng Yuan Hsia, Wei Yu Kao, Wing Yiu Lui, Wen Chieh Wu, Han Chieh Lin, Jaw Ching Wu

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23 Citations (Scopus)


Aims: This study aims to evaluate the risk factors for tumor recurrence beyond the Milan criteria (MC) for patients with hepatocellular carcinoma (HCC) after surgical resection (SR) in which salvage liver transplantation is relatively contraindicated. Methods: A total of 447 patients who underwent SR for HCC were enrolled consecutively. Among them, 248 and 199 patients were within the Milan criteria and beyond the Milan criteria (BMC group), respectively. Overall survival, recurrence, and disease-free survival were analyzed by multivariate analysis. Results: After a median follow-up of 34. 4 months, 130 patients died. Microvascular invasion, higher Edmondson stage of tumor cell differentiation, BMC group, and no anti-viral therapy were associated with poor overall survival. Multi-nodularity, higher Edmondson stage, BMC group, and no anti-viral therapy were independent risk factors for tumor recurrence, while BMC group and no anti-viral therapy were independent risk factors for disease-free survival. The Milan criteria, multi-nodularity, and microvascular invasion were used to stratify the patients into low-, medium-, and high-risk groups for tumor recurrence outside the MC and showed statistical significance (low vs. medium, p = 0. 011; low vs. high, p & 0. 001; medium vs. high, p = 0. 009). Conclusions: The combination of the MC, multi-nodularity, and microvascular invasion predict the post-operative recurrence of HCC and may provide a roadmap for further treatment.

Original languageEnglish
Pages (from-to)702-711
Number of pages10
JournalJournal of Gastrointestinal Surgery
Issue number4
Publication statusPublished - Jan 1 2013
Externally publishedYes



  • Hepatocellular carcinoma
  • Liver transplantation
  • Milan criteria
  • Surgical resection

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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