Impact of Surgical Margin on the Prognosis of Early Hepatocellular Carcinoma (≤5 cm): A Propensity Score Matching Analysis

Wang, Han; Yu, Hua; Qian, You–Wen; Cao, Zhen-Ying; Wu, Mengchao

doi:10.3389/fmed.2020.00139

Cited by 22 publications

(29 citation statements)

References 43 publications

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“…Whether surgical resection should be performed with wide or narrow surgical margin remains controversial in MVI-positive HCC patients. Several studies evaluated the relationship among surgical margin width, surgical outcomes and MVI status using measurement cut-offs for surgical margin width of 0.2, 0.5, and 1 cm ( 9 , 18 , 46 , 47 ). Since the incidence of MVI was correlated with tumor size, and MVI were reported to mainly present in the surgical margin adjacent to tumor, increased surgical margin width may improve surgical outcomes ( 31 ).…”

Section: And Selection Of Surgical Typementioning

confidence: 99%

“…Wang et al. ( 46 ) evaluated the influence of surgical margin on the prognosis of patients with HCC ≤ 5 cm and found that both the RFS and OS rates showed no significant difference in narrow (≤0.2 cm) and wide-margin (>0.2 cm) LR for the patients without MVI. However, for HCC patients with MVI, the narrow-margin LR showed poorer surgical outcomes than the wide-margin LR.…”

Section: And Selection Of Surgical Typementioning

confidence: 99%

“…MVI is widely acknowledged as an expression of aggressive biological behavior of HCC, and is currently one of the most critical factors associated with adverse prognosis after curative resection. The 5-year Disease Free Survival (DFS) rate ranges from 7.5% to 48% and the corresponding 5-year OS rate is 38.4% to 66% in HCC patients with MVI (7,9,14,22,31,33,34,(43)(44)(45)(46)(47). The reasons for this broad range may be due to a lack of consensus on the definition of MVI and selected patients with different tumor size in the above studies.…”

Section: And Surgical Outcomes Liver Resection (Lr)mentioning

confidence: 99%

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Revisiting Surgical Strategies for Hepatocellular Carcinoma With Microvascular Invasion

et al. 2021

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Although liver resection (LR) and liver transplantation (LT) are widely considered as potentially curative therapies for selected patients with hepatocellular carcinoma (HCC); however, there is still high risk of tumor recurrence in majority of HCC patients. Previous studies demonstrated that the presence of microvascular invasion (MVI), which was defined as the presence of tumor emboli within the vessels adjacent to HCC, was one of the key factors of early HCC recurrence and poor surgical outcomes after LR or LT. In this review, we evaluated the impact of current MVI status on surgical outcomes after curative therapies and aimed to explore the surgical strategies for HCC based on different MVI status with evidence from pathological examination. Surgical outcomes of HCC patients with MVI have been described as a varied range after curative therapies due to a broad spectrum of current definitions for MVI. Therefore, an international consensus on the validated definition of MVI in HCC is urgently needed to provide a more consistent evaluation and reliable prediction of surgical outcomes for HCC patients after curative treatments. We concluded that MVI should be further sub-classified into MI (microvessel invasion) and MPVI (microscopic portal vein invasion); for HCC patients with MPVI, local R0 resection with a narrow or wide surgical margin will get the same surgical results. However, for HCC patients with MI, local surgical resection with a wide and negative surgical margin will get better surgical outcomes. Nowadays, MVI status can only be reliably confirmed by histopathologic evaluation of surgical specimens, limiting its clinical application. Taken together, preoperative assessment of MVI is of utmost significance for selecting a reasonable surgical modality and greatly improving the surgical outcomes of HCC patients, especially in those with liver cirrhosis.

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Section: And Selection Of Surgical Typementioning

confidence: 99%

Section: And Selection Of Surgical Typementioning

confidence: 99%

Section: And Surgical Outcomes Liver Resection (Lr)mentioning

confidence: 99%

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Revisiting Surgical Strategies for Hepatocellular Carcinoma With Microvascular Invasion

et al. 2021

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“…Dates were not further divided by tumor sizes during the enrollment process, which would also have an impact on the patient's prognosis. Some studies found that different tumor sizes (31,32) and the shortest distance from the edge of the tumor to the plane of surgical margin (33)(34)(35) would significantly affect post-operative outcomes, yet no further discussion was done in the survival analysis in this study. The issues mentioned above need to be analyzed by further multi-center and extensive sample data.…”

Section: Discussionmentioning

confidence: 90%

Importance of Microvascular Invasion Risk and Tumor Size on Recurrence and Survival of Hepatocellular Carcinoma After Anatomical Resection and Non-anatomical Resection

Zeng

et al. 2021

Front. Oncol.

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Purpose: To establish a valid prediction model to prognose the occurrence of microvascular invasion (MVI), and to compare the efficacy of anatomic resection (AR) or non-anatomic resection (NAR) for hepatocellular carcinoma (HCC).Methods: Two hundred twenty-eight patients with HCC who underwent surgical treatment were enrolled. Their hematological indicators, MRI imaging features, and outcome data were acquired.Result: In the multivariable analysis, alpha-fetoprotein >15 ng/mL, neutrophil to lymphocyte ratio >3.8, corona enhancement, and peritumoral hypointensity on hepatobiliary phase were associated with MVI. According on these factors, the AUROC of the predictive model in the primary and validation cohorts was 0.884 (95% CI: 0.829, 0.938) and 0.899 (95% CI: 0.821, 0.967), respectively. Patients with high risk of MVI or those with low risk of MVI but tumor size >5 cm in the AR group were associated with a lower rate of recurrence and death than patients in the NAR group; however, when patients are in the state of low-risk MVI with tumor size >5 cm, there is no difference in the rate of recurrence and death between AR and NAR.Conclusion: Our predictive model for HCC with MVI is convenient and accurate. Patients with high-risk of MVI or low-risk of MVI but tumor size >5 cm executing AR is of great necessity.

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“…Partial hepatectomy is the first choice for patients with solitary liver cancer ≤ 5 cm and good liver function[ 9 ]. However, if the lesion is not fully resected, the residual MVI near the surgical margin may be an important cause of recurrence in patients with HCC[ 14 ], and some studies have demonstrated that extended resection can reduce the early recurrence rate of patients with liver cancer complicated with MVI[ 15 ]. Therefore, the present study has certain reference value for surgery choice in patients with liver cancer.…”

Section: Discussionmentioning

confidence: 99%

Prediction of microvascular invasion in solitary hepatocellular carcinoma ≤ 5 cm based on computed tomography radiomics

Peng¹,

Tan²,

Zhang³

et al. 2021

WJG

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BACKGROUND Liver cancer is one of the most common malignant tumors, and ranks as the fourth leading cause of cancer death worldwide. Microvascular invasion (MVI) is considered one of the most important factors for recurrence and poor prognosis of liver cancer. Thus, accurately identifying MVI before surgery is of great importance in making treatment strategies and predicting the prognosis of patients with hepatocellular carcinoma (HCC). Radiomics as an emerging field, aims to utilize artificial intelligence software to develop methods that may contribute to cancer diagnosis, treatment improvement and evaluation, and better prediction. AIM To investigate the predictive value of computed tomography radiomics for MVI in solitary HCC ≤ 5 cm. METHODS A total of 185 HCC patients, including 122 MVI negative and 63 MVI positive patients, were retrospectively analyzed. All patients were randomly assigned to the training group ( n = 124) and validation group ( n = 61). A total of 1351 radiomic features were extracted based on three-dimensional images. The diagnostic performance of the radiomics model was verified in the validation group, and the Delong test was applied to compare the radiomics and MVI-related imaging features (two-trait predictor of venous invasion and radiogenomic invasion). RESULTS A total of ten radiomics features were finally obtained after screening 1531 features. According to the weighting coefficient that corresponded to the features, the radiomics score (RS) calculation formula was obtained, and the RS score of each patient was calculated. The radiomics model exhibited a better correction and identification ability in the training and validation groups [area under the curve: 0.72 (95% confidence interval: 0.58-0.86) and 0.74 (95% confidence interval: 0.66-0.83), respectively]. Its prediction performance was significantly higher than that of the image features ( P < 0.05). CONCLUSION Computed tomography radiomics has certain predictive value for MVI in solitary HCC ≤ 5 cm, and the predictive ability is higher than that of image features.

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Impact of Surgical Margin on the Prognosis of Early Hepatocellular Carcinoma (≤5 cm): A Propensity Score Matching Analysis

Cited by 22 publications

References 43 publications

Revisiting Surgical Strategies for Hepatocellular Carcinoma With Microvascular Invasion

Revisiting Surgical Strategies for Hepatocellular Carcinoma With Microvascular Invasion

Importance of Microvascular Invasion Risk and Tumor Size on Recurrence and Survival of Hepatocellular Carcinoma After Anatomical Resection and Non-anatomical Resection

Prediction of microvascular invasion in solitary hepatocellular carcinoma ≤ 5 cm based on computed tomography radiomics

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