Limitations of predicting microvascular invasion in patients with hepatocellular cancer prior to liver transplantation

Abstract

Microvascular invasion (MVI) is well known to negatively influence outcomes following surgical treatment of hepatocellular cancer (HCC) patients. The aim of this study was to evaluate the rationale for prediction of MVI before liver transplantation (LT). Data of 200 HCC patients after LT were subject to retrospective analysis. MVI was present in 57 patients (28.5%). Tumor number (p = 0.001) and size (p = 0.009), and alpha-fetoprotein (p = 0.049) were independent predictors of MVI used to create a prediction model, defined as: 0.293x(tumor number) + 0.283x(tumor size in cm) + 0.164xloge(alpha-fetoprotein in ng/ml) (c statistic = 0.743). The established cut-off (≥2.24) was associated with sensitivity and specificity of 72%. MVI was not an independent risk factor for recurrence (p = 0.307), in contrast to tumor number (p = 0.047) and size (p < 0.001), alpha-fetoprotein (p < 0.001) and poor differentiation (p = 0.039). Recurrence-free survival at 5 years for patients without MVI was 85.9% as compared to 83.3% (p = 0.546) and 55.3% (p = 0.001) for patients with false negative and true positive prediction of MVI, respectively. The use of both morphological and biological tumor features enables effective pre-transplant prediction of high-risk MVI. Provided that these parameters are combined in selection of HCC patients for LT, pre-transplant identification of all patients with MVI does not appear necessary.

Hypo‐vascular hepatocellular carcinoma and liver transplantation: Morphological characteristics and implications on outcomes

“…Interestingly, we found no differences in the rates of microvascular invasion, a histological feature of HCC related to aggressive biological behavior, tumor recurrence, and survival, between hypovascular and hypervascular HCC lesions (47% vs 42%; P = .8). Published data are inconsistent regarding the aggressive nature of hypovascular lesions, which has shown dedifferentiation to be a predictor of microvascular invasion in univariate analysis . However, our findings highlight the potentially aggressive nature of hypovascular HCC in this patient population.…”

Overexpression of Epcam and CD133 Correlates with Poor Prognosis in Dual-phenotype Hepatocellular Carcinoma

“…Serum CA19-9 is also a marker of poor prognosis in pancreatic cancer and colorectal carcinoma 25-27 . Although the difference in recurrence-free survival between DPHCC patients and non-DPHCC patients was not statistically significant, survival tended to be lower in patients with DPHCC (P=0.058). Multiple tumor nodules were an independent risk factor for recurrence-free survival in HCC patients, probably owing to the high incidence of microvascular invasion and intrahepatic metastasis in these patients 28,29 . Multiple nodules are often accompanied by microsatellite tumors that are invisible to the naked eye; they cannot be accurately removed during surgery, which affects the tumor recurrence rate in HCC patients after hepatectomy.…”

Circular RNA 0068669 as a new biomarker for hepatocellular carcinoma metastasis

“…29 One study indicated that the recurrence-free survival at 5 year for patients without MVI was 85.9% as compared to 83.3% (P = .546) and 55.3% (P = .001) for patients with falsenegative and true-positive prediction of MVI, respectively. 30 MIV, normally defined as the presence of tumor emboli within the hepatic lobular central vein or the branch of portal vein, usually undetectable by preoperative imaging, was a prerequisite for intra-hepatic tumor dissemination. 29 Meanwhile, we found that hsa_circ_00068669 expression was associated with TMN stages (Table 1).…”