Microvascular invasion predicts a poor prognosis of solitary hepatocellular carcinoma up to 2 cm based on propensity score matching analysis

Wang, Han; Wu, Mengchao

doi:10.1111/hepr.13241

Cited by 49 publications

(31 citation statements)

References 42 publications

(92 reference statements)

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“…Unfortunately, about half of the HCC patients suffer from postoperative recurrence in a few years, resulting in surgical failure and poor prognosis (3). Microvascular invasion (MVI) is a histopathologic evidence of local aggression and is considered as a strong predictor of postoperative recurrence in HCC (3)(4)(5)(6). Based on the above research evidences, the 2017 Guidelines for Diagnosis and Treatment of Liver Cancer in China have required the HCC pathological diagnosis to supply the description of MVI status based on pathological examination and necessary immunohistochemical staining (7).…”

Section: Introductionmentioning

confidence: 99%

Preoperative Prediction Power of Imaging Methods for Microvascular Invasion in Hepatocellular Carcinoma: A Systemic Review and Meta-Analysis

et al. 2020

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Background: To compare the predictive power between radiomics and non-radiomics (conventional imaging and functional imaging methods) for preoperative evaluation of microvascular invasion (MVI) in hepatocellular carcinoma (HCC). Methods: Comprehensive publications were screened in PubMed, Embase, and Cochrane Library. Studies focusing on the discrimination values of imaging methods, including radiomics and non-radiomics methods, for MVI evaluation were included in our meta-analysis. Results: Thirty-three imaging studies with 5,462 cases, focusing on preoperative evaluation of MVI status in HCC, were included. The sensitivity and specificity of MVI prediction in HCC were 0.78 [95% confidence interval (CI): 0.75-0.80; I 2 = 70.7%] and 0.78 (95% CI: 0.76-0.81; I 2 = 0.0%) for radiomics, respectively, and were 0.73 (95% CI: 0.71-0.75; I 2 = 83.7%) and 0.82 (95% CI: 0.80-0.83; I 2 = 86.5%) for non-radiomics, respectively. The areas under the receiver operation curves for radiomics and non-radiomics to predict MVI status in HCC were 0.8550 and 0.8601, respectively, showing no significant difference. Conclusion: The imaging method is feasible to predict the MVI state of HCC. Radiomics method based on medical image data is a promising application in clinical practice and can provide quantifiable image features. With the help of these features, highly consistent prediction performance will be achieved in anticipation.

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Section: Introductionmentioning

confidence: 99%

Preoperative Prediction Power of Imaging Methods for Microvascular Invasion in Hepatocellular Carcinoma: A Systemic Review and Meta-Analysis

et al. 2020

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“…3,4 Small HCC has commonly been defined as a special type of hepatocellular carcinoma with a maximum tumor diameter 3 cm, 5,6 yet some studies also adopted a size cutoff of 2 cm or 5 cm to define small HCC. [7][8][9][10] Among all the various risk factors related to the recurrence of HCC, microvascular invasion (MVI) is the most important risk factor that is significantly associated with the early postoperative recurrence of HCC and is further confirmed as an independent predictor of both overall and disease-free survival after liver resection. [11][12][13] MVI is defined as the presence of tumor cells in portal veins, in large capsule vessels, or in a vascular space lined by endothelial cells.…”

Section: Introductionmentioning

confidence: 99%

“…9,10,20,21 Additionally, regarding HCC patients with tumors up to 2 cm, Wang et al recently concluded that MVI had a negative impact on the prognosis of solitary HCC up to 2 cm after curative hepatectomy. 7 Nevertheless, there still exist some high-quality studies concluding that MVI does not predict longterm survival for patients with HCC up to 2 cm. 8,22 Therefore, it still remains controversial whether MVI can predict long-term survival in solitary small HCC patients.…”

Section: Introductionmentioning

confidence: 99%

Effect of microvascular invasion on the postoperative long-term prognosis of solitary small HCC: a systematic review and meta-analysis

Chen

Zhang

Wang

et al. 2019

HPB

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Background: The effect of microvascular invasion (MVI) on the postoperative long-term prognosis of solitary small hepatocellular carcinoma remains controversial. We compared the long-term outcomes of MVI-positive and MVI-negative groups of patients with solitary small hepatocellular carcinoma. Methods: The PubMed, EMBASE, Cochrane Library, VIP, Wan Fang, and Sino Med databases were systematically searched to compare the long-term outcomes of MVI-positive and MVI-negative groups of patients with solitary small hepatocellular carcinoma from inception to November 1, 2018. The study outcomes, including overall survival (OS) and disease-free survival (DFS), were extracted independently by two authors. Results: Fourteen studies involving 3033 patients were evaluated. A meta-analysis of all 14 studies suggested that the OS of the MVI-positive group was significantly worse than that of the MVI-negative group (HR = 2.39, 95% CI = 2.02-2.84, I 2 = 22.8%; P < 0.001). Twelve studies were included in the metaanalysis of DFS, and MVI showed a worse prognosis (HR = 1.79, 95% CI = 1.59-2.02, I 2 = 25.3%; P < 0.001). Subgroup analysis demonstrated that MVI still showed a negative effect on the long-term OS and DFS of patients with solitary small HCC measuring up to 2 cm, 3 cm, or 5 cm. Conclusion: Microvascular invasion was a risk factor for poorer prognosis for solitary small hepatocellular carcinoma.

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“…The prognosis of patients with MVI following R0 resection remains far from promising, 1,26 but the application of p-TACE has always been questioned in clinic. 14,27,28 In this study, only 28.6% of patients with MVI received p-TACE, which was similar to previous report (34.9%).…”

Section: Discussionmentioning

confidence: 99%

“…In the recent decade, microvascular invasion (MVI) has been proposed as an aggressive biomarker of hepatocellular carcinoma (HCC). 1,2 The incidence of MVI is reported to be approximately 15% to 57%, 3 which would be higher after the advocation of MVI detecting in pathology. Patients with MVI are much more likely to endure recurrence and suffer a worse prognosis, 4,5 hence strategies intended to prevent the recurrence and improve the prognosis are well concerned in the heads of hepatobiliary surgeons.…”

Section: Introductionmentioning

confidence: 98%

<p>Not All Hepatocellular Carcinoma Patients with Microvascular Invasion After R0 Resection Could Be Benefited from Prophylactic Transarterial Chemoembolization: A Propensity Score Matching Study</p>

Wang

Lin

Xiao³

et al. 2020

CMAR

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Background: Prophylactic transarterial chemoembolization (p-TACE) is strongly recommended for hepatocellular carcinoma (HCC) patients with microvascular invasion (MVI), but the potential beneficiaries remain controversial. Methods: Data of HCC patients with MVI who underwent R0 resection between December 2013 and December 2015 were identified through the primary liver cancer big data. Disease-free survival (DFS) and overall survival (OS) were compared between patients who received p-TACE or not using Kaplan-Meier survival curves before and after propensity scoring match (PSM). Results: A total of 695 patients were eligible for this study, including 199 patients (28.6%) receiving p-TACE and 496 patients (71.4%) receiving resection alone. In the crude cohort, median DFS and OS were longer in the p-TACE group than those in the non-TACE group without significant differences (25.0 months vs 24.2 months, P=0.100; 48.0 months vs 46.5 months, P=0.150; respectively), but significant differences were observed both in DFS and OS (both P<0.05) after 1:1 PSM. p-TACE was identified as one of the independent risk factors of both DFS and OS using multivariate analysis in the matched cohort (HR=0.69, 95% CI=0.54-0.88; HR=0.66, 95% CI=0.50-0.88; respectively). Subgroup analysis showed that p-TACE could beneficiate patients if they were male, aged ≥50 years old, had HBV infection, preoperative AFP level ≥400 ng/mL, Child-Pugh grading A, no transfusion, single tumor, tumor diameter ≥5cm, Edmondson-Steiner grading I/II, capsule, or BCLC stage A, CNLC stage Ib, AJCC stage II both in DFS and OS (all P<0.05). Conclusion: With the current data, we concluded that not all HCC patients with MVI would be benefited from p-TACE, and p-TACE could benefit patients with "middle risk" according to the current staging systems.

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Microvascular invasion predicts a poor prognosis of solitary hepatocellular carcinoma up to 2 cm based on propensity score matching analysis

Abstract: MVI had a negative impact on the prognosis of solitary HCC up to 2 cm after curative hepatectomy. The 8th edition of the American Joint Committee on Cancer staging system could be improved by subdividing solitary HCC up to 2 cm according to MVI.

Cited by 49 publications

References 42 publications

Preoperative Prediction Power of Imaging Methods for Microvascular Invasion in Hepatocellular Carcinoma: A Systemic Review and Meta-Analysis

Preoperative Prediction Power of Imaging Methods for Microvascular Invasion in Hepatocellular Carcinoma: A Systemic Review and Meta-Analysis

Effect of microvascular invasion on the postoperative long-term prognosis of solitary small HCC: a systematic review and meta-analysis

<p>Not All Hepatocellular Carcinoma Patients with Microvascular Invasion After R0 Resection Could Be Benefited from Prophylactic Transarterial Chemoembolization: A Propensity Score Matching Study</p>

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