Microvascular invasion has limited clinical values in hepatocellular carcinoma patients at Barcelona Clinic Liver Cancer (BCLC) stages 0 or B

Zhu, Xiao‐Dong; Ji, Yuan; Ding, Guangyu; Shi, Guo‐Ming; Shen, Ying‐Hao; Zhou, Jian; Fan, Jian‐Gao; Sun, Hui‐Chuan

doi:10.1186/s12885-017-3050-x

Cited by 44 publications

(33 citation statements)

References 27 publications

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“…Most reports that evaluated prognostic factors for HCC patients have not included serosal invasion . Furthermore, although some reports have evaluated tumor rupture and invasion into adjacent organs, microscopic serosal invasion has rarely been assessed .…”

Section: Discussionmentioning

confidence: 99%

“…One of the reasons for this poor prognosis is the high incidence of recurrence after hepatectomy . Patient characteristics, underlying liver disease, and tumor‐related factors are reportedly prognostic factors for HCC after hepatectomy . Regarding tumor‐related factors, the number of tumors, maximum size of tumors, presence of vascular invasion, and histological type of tumors have all been reported as prognostic factors for patients with HCC .…”

Section: Introductionmentioning

confidence: 99%

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Serosal invasion is a strong prognostic factor for hepatocellular carcinoma after hepatectomy

Sakamoto

Ogawa

Tohyama

et al. 2018

Hepatology Research

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Aim: The clinical impact of serosal invasion by hepatocellular carcinoma (HCC) remains unclear. This study aimed to clarify the significance of serosal invasion as a prognostic factor for patients who underwent hepatectomy for HCC.Methods: This retrospective study investigated patients who underwent hepatectomy for HCC between October 2003 and September 2016 in Ehime University Hospital (Toon, Japan). A total of 161 cases were enrolled after excluding cases of concomitant distant metastasis, macroscopic tumor remnant, mixed HCC, and rehepatectomy. We classified these 161 patients into groups with serosal invasion detected (S[+]) and serosal invasion undetected (S[À]). We compared patient characteristics, perioperative data, pathological findings, and prognosis between S(+) and S(À) groups.Results: Serosal invasion was observed in 19 of the 161 patients (12%). The 5-year recurrence-free survival rate was lower for S(+) (13.0%) than for S(À) (28.7%, P = 0.006). The 5-year overall survival (OS) rate was lower for S(+) (24.7%) than for S(À) (63.9%, P < 0.001). Regarding OS, serosal invasion, preoperative α-fetoprotein value, presence of invasion to hepatic veins, and liver cirrhosis were independent predictors in multivariate analyses. The 3-year OS rate after recurrence was poorer in the S(+) group (22.9%) than in the S(À) group (49.7%, P = 0.001).Conclusions: Serosal invasion was a strong predictor of worse outcomes after hepatectomy for HCC. Patients showing serosal invasion need close postoperative follow-up or consideration of adjuvant treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Serosal invasion is a strong prognostic factor for hepatocellular carcinoma after hepatectomy

Sakamoto

Ogawa

Tohyama

et al. 2018

Hepatology Research

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“…MVI occurs in 15%–60% of resected specimens from patients with HCC . Previous studies have confirmed MVI to be a poor prognostic factor of tumor recurrence and long‐term survival after R0 LR . There is still no universally accepted adjuvant therapy after R0 LR for patients with HCC with MVI, although adjuvant therapies have been shown to be beneficial in selected patients .…”

Section: Introductionmentioning

confidence: 99%

An Eastern Hepatobiliary Surgery Hospital Microvascular Invasion Scoring System in Predicting Prognosis of Patients with Hepatocellular Carcinoma and Microvascular Invasion After R0 Liver Resection: A Large-Scale, Multicenter Study

et al. 2019

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Background. Microvascular invasion (MVI) is associated with poor postoperative survival outcomes in patients with hepatocellular carcinoma (HCC). An Eastern Hepatobiliary Surgery Hospital (EHBH) MVI scoring system was established to predict prognosis in patients with HCC with MVI after R0 liver resection (LR) and to supplement the most commonly used classification systems. Materials and Methods. Patients with HCC with MVI who underwent R0 LR as an initial therapy were included. The EHBH-MVI score was developed from a retrospective cohort from 2003 to 2009 to form the training cohort. The variables associated with overall survival (OS) on univariate analysis were subsequently investigated using the log-rank test, and the EHBH-MVI score was developed using the Cox regression model. It was validated using an internal prospective cohort from 2011 to 2013 as well as three independent external validation cohorts.Results. There were 1,033 patients in the training cohort; 322 patients in the prospective internal validation cohort; and 493, 282, and 149 patients in the three external validation cohorts, respectively. The score was developed using the following factors: α-fetoprotein level, tumor encapsulation, tumor diameter, hepatitis B e antigen positivity, hepatitis B virus DNA load, tumor number, and gastric fundal/esophageal varicosity. The score differentiated two groups of patients (≤4, >4 points) with distinct long-term prognoses outcomes (median OS, 55.8 vs. 19.6 months; p < .001). The predictive accuracy of the score was greater than the other four commonly used staging systems for HCC. Conclusion. The EHBH-MVI scoring system was more accurate in predicting prognosis in patients with HCC with MVI after R0 LR than the other four commonly used staging systems. The score can be used to supplement these systems. The Oncologist 2019;24:e1476-e1488 Implications for Practice: Microvascular invasion (MVI) is a major determinant of survival outcomes after curative liver resection for patients with hepatocellular carcinoma (HCC). Currently, there is no scoring system aiming to predict prognosis of patients with HCC and MVI after R0 liver resection (LR). Most of the widely used staging systems for HCC do not use MVI as an independent risk factor, and they cannot be used to predict the prognosis of patients with HCC and MVI after surgery. In this study, a new Eastern Hepatobiliary Surgery Hospital (EHBH) MVI scoring system was established to predict prognosis Hepatobiliary of patients with HCC and MVI after R0 LR. Based on the results of this study, postoperative adjuvant therapy may be recommended for patients with HCC and MVI with an EHBH-MVI score >4. This score can be used to supplement the currently used HCC classifications to predict postoperative survival outcomes in patients with HCC and MVI. SI conversion factors: To convert albumin to grams per liter, multiply by 10; α-fetoprotein to micrograms per milliliter, multiply by 1; alanine aminotransferase to microkatals per liter, multiply by 0.0167; creatinine to micro...

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“…No direct evidence can be provided on this issue, while here we offer two likely examples for a brief glimpse into the problem. One is Huang et al [ 16 ] and the colleagues reporting significantly different MVI rate (25.3 vs. 32.5%, p < 0.001) in two similar cohorts (Table 1 ). Applying the same eligibility criteria in the same ethnic group, the discovery and validation cohorts in the study are similar in a variety of aspects regarding age, gender percentage, HCC etiology, liver cirrhosis, Barcelona Clinic Liver Cancer (BCLC) stage, mean tumor size, tumor number, tumor encapsulation type (complete or none), histological grade, and AFP level, except for types of resection (anatomic or non-anatomic) ( p = 0.046).…”

Section: Discussionmentioning

confidence: 96%

Need for normalization: the non-standard reference standard for microvascular invasion diagnosis in hepatocellular carcinoma

Wang

2018

World J Surg Onc

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BackgroundPreoperative microvascular invasion (MVI) assessment in hepatocellular carcinoma (HCC) is one of the current research focuses, with studies reporting controversial results regarding MVI-associated risk factors. As a possible source of bias, reported MVI rate (percentage of MVI-positive patients) varies a lot among studies. Pathological examination should have been the golden criteria of MVI diagnosis, but no standard and generally adopted pathological examination protocol exists.Methods and resultsIt is highly possible that underestimated pathological diagnosis of MVI exists. We present two likely examples to stress the problem and indicate the root of the problem partially being an unreliable pathological examination. Results of studies basing on unreliable reference standard can be less convincing and even misleading, which is the most basic and fundamental problem in this research field.ConclusionThere is an urgent need to settle the disputes regarding pathological sampling, microscopy, and reporting, in order to promote future academic exchange and consensus development on MVI assessment. Several concerns about pathological MVI assessment should be focused on in the future research as we put up in the review.

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Microvascular invasion has limited clinical values in hepatocellular carcinoma patients at Barcelona Clinic Liver Cancer (BCLC) stages 0 or B

Cited by 44 publications

References 27 publications

Serosal invasion is a strong prognostic factor for hepatocellular carcinoma after hepatectomy

Serosal invasion is a strong prognostic factor for hepatocellular carcinoma after hepatectomy

An Eastern Hepatobiliary Surgery Hospital Microvascular Invasion Scoring System in Predicting Prognosis of Patients with Hepatocellular Carcinoma and Microvascular Invasion After R0 Liver Resection: A Large-Scale, Multicenter Study

Need for normalization: the non-standard reference standard for microvascular invasion diagnosis in hepatocellular carcinoma

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