We agree with Dr Selby regarding the predictive value of major vascular invasion. We also use noninvasive imaging techniques extensively and consider major vascular invasion an absolute contraindication to liver transplantation. Even so, major vascular invasion was observed in the explanted livers of 6 of our patients.
Four patients had poorly differentiated tumors and 2 had well- to moderately differentiated tumors (data not included in the text). We did perform a multivariate analysis excluding pTNM stage, and major vascular invasion was not a statistically significant independent factor in either patient survival or tumor recurrence analysis, although it showed statistical significance in univariate analysis.
Tamura S, Kato T, Reddy R, Tzakis A. Impact of Histological Grade of Hepatocellular Carcinoma on the Outcome of Liver Transplantation—Invited Response. Arch Surg. 2001;136(1):31. doi:10.1001/archsurg.136.1.31