Pattern of macrovascular invasion in hepatocellular carcinoma

Abstract

Background and aims In patients with hepatocellular carcinoma (HCC), macrovascular invasion (MaVI) limits treatment options and decreases survival. Detailed data on the relationship between MaVI extension and patients' characteristics, and its impact on patients' outcome are limited. We evaluated the prevalence and extension of MaVI in a large cohort of consecutive HCC patients, analysing its association with liver disease and tumour characteristics, as well as with treatments performed and patients' survival. Methods We analysed data of 4774 patients diagnosed with HCC recorded in the Italian Liver Cancer (ITA.LI.CA) database (2008‐2018). Recursive partition analysis (RPA) was performed to evaluate interactions between MaVI, clinical variables and treatment, exploring the inter‐relationship determining overall survival. Results MaVI prevalence was 11.1%, and median survival of these patients was 6.0 months (95% CI, 5.1‐7.1). MaVI was associated with younger age at diagnosis, presence of symptoms, worse Performance Status (PS) and liver function, high alphafetoprotein levels and large HCCs. MaVI extension was associated with worse PS, ascites and greater impairment in liver function. RPA identified patients' categories with different treatment indications and survival, ranging from 2.4 months in those with PS > 1 and ascites, regardless of MaVI extension (receiving best supportive care in 90.3% of cases), to 14.1 months in patients with PS 0‐1, no ascites and Vp1‐Vp2 MaVI (treated with surgery in 19.1% of cases). Conclusions MaVI presence and extension, together with PS and ascites, significantly affect patients' survival and treatment selection. The decision tree based on these parameters may help assess patients' prognosis and inform therapeutic decisions.

Portal Vein Tumor Thrombosis and Hepatocellular Carcinoma – The Changing Tides

“…The presence and extension of vascular invasion along with the performance status and ascites have a significant impact on patient survival and the choice of therapeutics. 49 With the presence of aforementioned factors and most treatments being contraindicated in this setting, these patients perform poor with lower median OS of 2-4 months after best supportive care (BSC). 50…”

“…Although the selection of the treatment modality plays a significant role, it's also imperative to know that vessel involvement itself has a central role in possible progression and prognosis of the HCC in these patients. 49,151 A nation-wide survey by the Liver Cancer Study Group of Japan reported survival benefits for LR in HCC patient with PVTT. 152 Patients were divided into a LR group (n=2,093) and a non-LR group (received treatment TACE, ablation, chemotherapy, BSC, and other treatments).…”

“…The presence and extension of vascular invasion along with the performance status and ascites have a significant impact on patient survival and the choice of therapeutics. 49 …”

“…Although the selection of the treatment modality plays a significant role, it’s also imperative to know that vessel involvement itself has a central role in possible progression and prognosis of the HCC in these patients. 49 , 151 …”

Recalibrating survival prediction among patients receiving trans‐arterial chemoembolization for hepatocellular carcinoma

“…Conversely, a more weight was observed for bilirubin, but despite this the Pre-TACE-Predict model underestimated, thus tumour features probably affect prognosis more than liver function tests. All in all, we feel that the lower weight attributed by the recalibrated model to macroscopic vascular invasion and aetiology of liver disease might more closely reflect the population of patients who in the future will be treated with TACE, as the widespread treatment of HCV patients with DAA will likely equalize this variable by avoiding the risk of death due to liver decompensation following successful oncological treatment, while the advent of other therapeutic options with competitive overall survival rates and a lower likelihood of posttreatment hepatic decompensation-such as trans-catheter arterial radio-emobolization and new systemic treatments-will decrease the proportion of patients with macroscopic vascular invasion undergoing TACE [30][31][32][33]. With the exception of aetiology and macrovascular invasion, the remaining prognostic factors (multiplicity, size, AFP, albumin and bilirubin) are present even in the m-HAP-III model.…”