Postoperative adjuvant treatment strategy for hepatocellular carcinoma with microvascular invasion: a non-randomized interventional clinical study

Abstract

Background: Microvascular invasion (MVI) is considered to be one of the important prognostic factors that affect postoperative recurrence in patients with hepatocellular carcinoma (HCC) with variable results across their treatment options. This study was carried out to investigate efficacy of postoperative adjuvant RT in HCC patients with MVI. Methods: This was single center, prospective study carried out in HCC patients with MVI, aged 35-72 years. All patients were non-randomly allocated to receive standard postoperative treatment of HBV/HCV and nutritional therapy or RT in addition to standard postoperative treatment (1:1). The primary endpoints assessed were relapse-free survival and overall survival. The prognostic factors associated with survival outcomes were also analyzed. The safety events were graded according to NCI-CTCAE v4.03 criteria. Results: Of the 115 patients eligible for study, 59 patients were included in analysis. Univariate analysis revealed that MVI classification (P = 0.009), post-operative treatment strategies (P = 0.009) were prognostic factors for worst RFS; tumor size (P = 0.011), MVI classification (P = 0.005) and post-operative treatment (P = 0.015) were associated for OS. The 1-, 2-, 3-year RFS rates were 86.2, 70.5 and 63.4% for patients in RT group, and 46.4, 36.1, and 36.1% in control group. For OS, corresponding rates were 96.6, 80.7, and 80.7% for patients in RT group and 79.7, 58.3, and 50.0% in control group. Subgroup classification of HCC patients according to low risk MVI showed significantly longer RFS (P = 0.035) and OS (P = 0.004) in RT group than control group, while for high risk MVI, RT depicted longer OS than control group with no significance (P = 0.106). Toxicities were usually observed in acute stage with no grade 4 toxicities.

Using deep learning to predict microvascular invasion in hepatocellular carcinoma based on dynamic contrast-enhanced MRI combined with clinical parameters

“…The presence of MVI is considered as an independent prognostic factor associated with the early recurrence and poor survival after both resection and transplantation (Lim et may be suitable for the patient with small-size HCC displayed MVI (Imai et al 2018; Lee et al 2021) because it has been reported that among the patients with high risk of MVI, the cumulative 2-year recurrence rate was 90.0% in the surgical resection group, while 30.6% in the RFA group (Lee et al 2021). Furthermore, additional adjuvant or targeted therapies were reported to improve survival for HCC patients with MVI compared to surgical resection alone (Sun et al 2016; Wang et al 2020b;Zhang et al 2019). So preoperative prediction of MVI status is clinically signi cant for surgical decision making and other treatment strategies to improve patient prognosis.…”

3,3′-Diindolylmethane Suppresses the Growth of Hepatocellular Carcinoma by Regulating Its Invasion, Migration, and ER Stress-Mediated Mitochondrial Apoptosis

“…HCC is still considered one of the most dreadful diseases that can cause an increased incidence of intrahepatic and extrahepatic metastasis with a high mortality rate in both developed and developing countries [ 1 , 56 ]. Due to its poor prognosis and lack of management with adjuvant therapies, the only treatment for HCC is hepatic resection and liver transplantation with the minimum outcome, systemic toxicity, distant metastasis, and drug resistance.…”

Establishment, validation and evaluation of predictive model for early relapse after R0 resection in hepatocellular carcinoma patients with microvascular invasion

“…Postoperative adjuvant treatment, such as postoperative interventional therapy and radiotherapy, could improve the prognosis of HCC patients with MVI [ 31 , 32 ]. In our study, the postoperative interventional therapy/radiotherapy was not significantly associated with the prognosis of patients, which might be attributed to the different baseline data between patients with and without treatment and the small sample size.…”