Microvascular invasion of single small hepatocellular carcinoma ≤3 cm: Predictors and optimal treatments

Abstract

BackgroundSmall hepatocellular carcinomas (HCC ≤3 cm) are generally considered to have low malignant potential; however, some of them display pathological microvascular invasion (MVI).MethodsBetween 1991 and 2013, 414 patients with a single HCC ≤3 cm underwent curative hepatic resection (HR). Predictors for MVI were identified. Using another cohort (149 patients during 2000‐2014), our predictors for MVI in HCC ≤3 cm were validated. In 428 patients with a single HCC ≤3 cm who had predictors for MVI, survival was compared among anatomical HR (n = 149), partial HR (n = 227), and radiofrequency ablation (RFA) (n = 52).ResultsThe positive rate of MVI reached 40.6% (168/414 patients). Independent predictors for MVI were as follows: tumor diameter ≥2 cm (odds ratio 1.84, P = .0052), alpha‐fetoprotein (AFP) ≥200 ng/mL (odds ratio 1.82, P = .0466), and des‐gamma‐carboxy prothrombin (DCP) ≥40 mAU/mL (odds ratio 1.79, P = .0126). Matching at least one predictor among these three could predict MVI in HCC ≤3 cm well (sensitivity 82.8%, positive predictive value [PPV] 48.7%). This criterion could also predict MVI in HCC ≤3 cm well in another cohort (sensitivity 82.8%, PPV 30.3%). In patients with single HCC ≤3 cm matching our criterion for predicting MVI, anatomical HR led to significantly better survival in both disease‐free (hazard ratio 0.689, P = .0231) and overall (hazard ratio 0.589, P = .0316) survivals.ConclusionMatching at least one factor among three (tumor diameter ≥2 cm, AFP ≥200 ng/mL, or DCP ≥40 mAU/mL) can predict MVI in HCC ≤3 cm. In such patients, anatomical HR would be recommended to improve survival.

Preoperative circulating tumor cells to predict microvascular invasion and dynamical detection indicate the prognosis of hepatocellular carcinoma

“…Recent studies have demonstrated that tumor diameter, tumor number, degree of differentiation and serum level of prothrombin induced by vitamin K absence-II (PIVKA-II) were predictors of MVI [ 6 ]. One study reported that independent predictors of MVI included tumor diameter > 2 cm, alpha-fetoprotein (AFP) > 200 ng/mL and PIVKA-II > 40 mAU/mL [ 7 ]. Previous research has reported that the incidence of MVI ranged from 15 to 57% in HCC specimens and was associated with tumor size, AFP and typical imaging features [ 8 ].…”

Circulating Tumor Cells to Predict Microvascular Invasion and Dynamical Detection Indicate Prognosis of Hepatocellular Carcinoma

“…The most signi cant reason for the dismal prognosis is vascular invasion. Previous research has demonstrated that vascular invasion is a vital risk factor for the prognosis of HCC patients after curative hepatectomy [31]. Disappointingly, routine diagnostic methods are unable to identify the HCC patient subpopulation at high risk of having microvascular invasion preoperatively.…”

“…Recent studies have demonstrated that tumor diameter, tumor number, degree of differentiation and serum level of prothrombin induced by vitamin K absence-II (PIVKA-II) were predictors of MVI [7,8]. A study reported that independent predictors of MVI were tumor diameter >2 cm, alphafetoprotein (AFP) >200 ng/mL and PIVKA-II >40 mAU/ml [9]. Previous research reported that the incidence of MVI ranged from 15% to 57% in HCC specimens and was associated with tumor size, AFP and typical image features [10].…”

Utility of scoring systems combining the product of tumor number and size with liver function for predicting the prognosis of patients with hepatocellular carcinoma after hepatectomy

“…Notably, the NxS factor can be obtained from imaging modalities such as computed tomography (CT) or magnetic resonance imaging (MRI), and information on pathological vessel involvement is not needed. Although vascular invasion, one of the TNM staging components, is considered a prognostic factor, a peripheral vascular invasion is usually observed as microvascular invasion in the resected specimen and underestimated preoperatively (29,30). Thus, unsuccessful preoperative assessment causes a potential limitation in the TNM and TNM-based systems due to the discrepancy between the pre-and postoperative status of HCC patients.…”