Indication of Liver Transplantation for Hepatocellular Carcinoma Should Be Reconsidered in Case of Microvascular Invasion and Multilocular Tumor Occurrence

Abstract

Liver transplantation (LT) is routinely performed for hepatocellular carcinoma (HCC) in cirrhosis without major vascular invasion. Although the adverse influence of microvascular invasion is recognized, its occurrence does not contraindicate LT. We retrospectively analyzed in our LT cohort the significance of microvascular invasion on survival and demonstrate bridging procedures. At our hospital, 346 patients were diagnosed with HCC, 171 patients were evaluated for LT, and 153 were listed at Eurotransplant during a period of 11 years. Among these, 112 patients received LT and were included in this study. Overall survival after 1, 3 and 5 years was 86.3%, 73.9%, and 67.9%, respectively. Microvascular invasion led to significantly reduced overall (p = 0.030) and disease-free survival (p = 0.002). Five-year disease-free survival with microvascular invasion was 10.5%. Multilocular tumor occurrence with simultaneous microvascular invasion revealed the worst prognosis. In our LT cohort, predominant bridging treatment was transarterial chemoembolization (TACE) and the number of TACE significantly correlated with poorer overall survival after LT (p = 0.028), which was confirmed in multiple Cox regression analysis for overall and disease-free survival (p = 0.015 and p = 0.011). Microvascular tumor invasion is significantly associated with reduced prognosis after LT, which is aggravated by simultaneous occurrence of multiple lesions. Therefore, indication strategies for LT should be reconsidered.

Global research status and frontiers on microvascular invasion of hepatocellular carcinoma: A bibliometric and visualized analysis

“…( 32 ) also confirmed that p-TACE was an independent protective factor in the subgroup of tumor ≤ 5 cm but not in the subgroup of tumor > 5. At present, the research suggested that MVI after resection is not a contraindication for liver transplantation (LT) and demonstrated that LT should be reconsidered in case of MVI and multilocular tumor occurrence ( 33 ). However, further studies with improved design are needed in this area.…”

Liver transplantation for HCC in cirrhosis: Are Milan criteria outdated?

“…In particular, tumor biology seems to be decisive for prognosis after LT 13 . In addition to grading and microvascular infiltration 14 , the response to locoregional therapy is an important prognostic predictor 13 . Furthermore, the identification of patients with an increased risk of recurrence after resection is also important, because nearly half of the patients with early -stage HCC experience recurrence after resection mainly within 2 years after surgery 15 .…”

An Image Retrieval Pipeline in a Medical Data Integration Center

“…The keyword generator is designed to annotate DICOM and PNG data based on Flask: 1) For DICOM images, the ingest component extracts and indexes the standard DICOM header. Over 100 DICOM images of 7 anonymized test patients in the research project TOMAS [3] are extracted and indexed in ES. ; 2) Alternatively, for unannotated PNG images, the component uses a "Deep Learning (DL) keyword generator" to generate appropriate instance-level image captions.…”