Effect of Microvascular Invasion Risk on Early Recurrence of Hepatocellular Carcinoma After Surgery and Radiofrequency Ablation

Abstract

Objective: We compared surgical resection (SR) and radiofrequency ablation (RFA) as first-line treatment in patients with hepatocellular carcinoma (HCC) based on the risk of microvascular invasion (MVI). Background: The best curative treatment modality between SR and RFA in patients with HCC with MVI remains unclear. Methods: Data from 2 academic cancer center-based cohorts of patients with a single, small (≤3 cm) HCC who underwent SR were used to derive (n = 276) and validate (n = 101) prediction models for MVI using clinical and imaging variables. The MVI prediction model was developed using multivariable logistic regression analysis and externally validated. Early recurrence (<2 years) based on risk stratification between SR (n = 276) and RFA (n = 240) was evaluated via propensity score matching. Results: In the multivariable analysis, alpha-fetoprotein (≥15 ng/mL), protein induced by vitamin K absence-II (≥48 mAU/mL), arterial peritumoral enhancement, and hepatobiliary peritumoral hypointensity on magnetic resonance imaging were associated with MVI. Incorporating these factors, the area under the receiver operating characteristic curve of the predictive model was 0.87 (95% confidence interval: 0.82–0.92) and 0.82 (95% confidence interval: 0.74–0.90) in the derivation and validation cohorts, respectively. SR was associated with a lower rate of early recurrence than RFA based on the risk of MVI after propensity score matching (P < 0.05). Conclusions: Our model predicted the risk of MVI in patients with a small (≤ 3 cm) HCC with high accuracy. Patients with MVI who had undergone RFA were more vulnerable to recurrence than those who had undergone SR.

Intraprocedurally EOB-MRI/US fusion imaging focusing on hepatobiliary phase findings can help to reduce the recurrence of hepatocellular carcinoma after radiofrequency ablation

“…As expected, the overall recurrence rate of lesions with HBP findings (73.7%) was much higher than those without (42.9%), confirming the reported view that the presence of HBP findings is harmful to the prognosis of HCC [12,14]. Specifically, in our study, both LTP and IDR were higher in lesions with HBP findings (LTP: 23.6%, IDR: 50.0%) than those without (LTP: 10.4%, IDR: 32.5%).…”

“…They are distributed around the larger primary tumors and have the same tumor clonality as the primary lesions [33]. Obviously, the results of LTP and IDR shown in this study have further confirmed the relationship between HBP findings and MVI, as the previous literature described [12,14]. More importantly, due to the mechanism of LTP occurrence and our findings, we put forward a new hypothesis of the potential relationship between HBP findings and microsatellite foci.…”

“…Recently, EOB-MRI has been recommended by several guidelines as the primary or firstline diagnostic imaging modality for the noninvasive diagnosis of HCC [10,11]. It is of utmost importance that, when using the pathology findings as the reference standard, the findings of peritumoral hypointensity and the irregular protruding margin in the HBP of EOB-MRI (in the following, we abbreviate them to 'HBP findings') are used to preoperatively predict the MVI of HCC; the HBP findings are supposed to be associated with an early recurrence of surgical resection and RFA [12][13][14][15].…”

Combined hepatocellular-cholangiocarcinoma: which preoperative clinical data and conventional MRI characteristics have value for the prediction of microvascular invasion and clinical significance?

“…Our study also showed that irregular arterial phase peritumoral enhancement was a significant MRI finding predicting the MVI of cHCC-CCA. Many reports [18,20,39] have shown that arterial peritumoral enhancement is an independent predictive factor of MVI in HCC. To date, few studies have described the relationship between peritumoral enhancement of cHCC-CCA and MVI.…”

<p>A Novel Scoring System for Patients with Recurrence of Hepatocellular Carcinoma After Undergoing Minimal Invasive Therapies</p>

“…markers such as NLR, PLR, and prognostic nutritional index; and 20,21 (5) pathological markers such as microvascular invasion and lowly-differentiated neoplasm. 22,23 But little attention has been paid to the relationship between these indicators or combined markers and prognosis of patients with HCC treated with TACE plus percutaneous ablation. However, the present study illustrated the development of a novel scoring system based on gender, tumor number, AFP, Fib, and APR selected by univariate and multivariate analysis, which might evaluate the recurrence risk of patients with HCC after undergoing combined therapies.…”