A novel classification in predicting prognosis and guiding postoperative management after R0 liver resection for patients with hepatocellular carcinoma and microvascular invasion

Wang, Kang; Xiang, Yan-Jun; Yu, Hongming; Cheng, Yuqiang; Qin, Yingyi; Zhang, Xiuping; Zheng, Yun; Shan, Yunfeng; Dong, Hui; Lau, Wan Yee; Cheng, Shuqun

doi:10.1016/j.ejso.2021.12.466

Cited by 12 publications

(18 citation statements)

References 37 publications

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“…In this study, MVI‐positive patients who received PA‐TACE had significantly higher survival rates. Many studies have shown that PA‐TACE can significantly prolong survival in MVI‐positive patients but not in MVI‐negative patients 11–17 . A meta‐analysis showed that PA‐TACE not only failed to improve outcomes in MVI‐negative patients but may potentially promote postoperative recurrences in certain patients 25 .…”

Section: Discussionmentioning

confidence: 99%

“…Before receiving PA‐TACE, patients will be routinely tested for liver function, tumour markers, computed tomography (CT), and/or magnetic resonance imaging (MRI) to determine whether the tumour has recurred or metastasized. During the operation of PA‐TACE, we placed the hepatic arterial catheter through the femoral artery into the proper hepatic artery using the Seldinger technique and injected a mixture of appropriate chemotherapeutic (Fluorouracil, epirubicin, and platinum) and embolic agents (lipiodol and gelatin sponge) through the catheter into the residual liver based on a comprehensive assessment of the patient's body surface area, physical fitness, and residual liver volume 8–17 …”

Section: Methodsmentioning

confidence: 99%

“…During the operation of PA-TACE, we placed the hepatic arterial catheter through the femoral artery into the proper hepatic artery using the Seldinger technique and injected a mixture of 230 -UNITED EUROPEAN GASTROENTEROLOGY JOURNAL appropriate chemotherapeutic (Fluorouracil, epirubicin, and platinum) and embolic agents (lipiodol and gelatin sponge) through the catheter into the residual liver based on a comprehensive assessment of the patient's body surface area, physical fitness, and residual liver volume. [8][9][10][11][12][13][14][15][16][17]…”

Section: Evaluation Of Microvascular Invasion and Selection Of Postop...mentioning

confidence: 99%

“…The proposed mechanism of postoperative adjuvant transarterial chemoembolisation (PA‐TACE) is the elimination of intrahepatic micro‐metastases, residual small foci, or dissociated cancer cells due to an extrusion at the time of surgery 7–9 . However, the role of TACE in tumour recurrence remains somewhat controversial with some investigators suggesting that it may only be beneficial for specific subgroups of patients and has no impact on survival outcomes beyond 1 year 8–17 . A meta‐analysis showed that certain subgroups of patients with HCC benefited most from PA‐TACE, especially those with concomitant microvascular invasion (MVI) 9 .…”

Section: Introductionmentioning

confidence: 99%

“… 7 , 8 , 9 However, the role of TACE in tumour recurrence remains somewhat controversial with some investigators suggesting that it may only be beneficial for specific subgroups of patients and has no impact on survival outcomes beyond 1 year. 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 A meta‐analysis showed that certain subgroups of patients with HCC benefited most from PA‐TACE, especially those with concomitant microvascular invasion (MVI). 9 In contrast, there appeared to be no benefit of PA‐TACE when assessing only tumour size (⩾ 5 cm) alone.…”

Section: Introductionmentioning

confidence: 99%

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Postoperative adjuvant transarterial chemoembolisation improves survival of hepatocellular carcinoma patients with microvascular invasion: A multicenter retrospective cohort

et al. 2023

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Background:We aimed to investigate the efficacy of postoperative adjuvant transarterial chemoembolisation (PA-TACE) in patients with hepatocellular carcinoma (HCC) complicated by microvascular invasion (MVI). Methods:A retrospective analysis of 1505 patients with HCC who underwent hepatectomy at four medical centers, including 782 patients who received PA-TACE and 723 patients who did not receive adjuvant PA-TACE, has been conducted. Propensity score matching (PSM) (1:1) was performed on the data to minimise selection bias, which resulted in a balanced clinical profile between groups.Results: After PSM, 620 patients who received PA-TACE and 620 patients who did not receive PA-TACE were included. Disease-free survival (DFS, 1-, 2-, and 3-year: 88%-68%-61% vs. 70%-58%-51%, p < 0.001) and overall survival (OS, 1-, 2-, and 3year: 96%-89%-82% vs. 89%-77%-67%, p < 0.001) were significantly higher in patients who received PA-TACE than in those who did not. Patients with MVI who received PA-TACE had significantly higher DFS (1-, 2-, and 3-year: 68%-57%-48% vs. 46%-31%-27%, p < 0.001) and OS (1-, 2-, and 3-year: 96%-84%-77% vs. 79%-58%-40%, p < 0.001) than those who did not receive PA-TACE. Among the six different liver cancer stages, MVI-negative patients did not have significant survival outcomes from PA-TACE (p > 0.05), whereas MVI-positive patients achieved higher DFS and OS from it (p < 0.05). Liver dysfunction, fever, and nausea/vomiting were the most common adverse events in patients receiving PA-TACE. There was no significant difference in grade 3 or 4 adverse events between the groups (p > 0.05). Conclusions:Postoperative adjuvant transarterial chemoembolisation has a good safety profile and may be a potentially beneficial treatment modality for survival outcomes in patients with HCC, especially those with concomitant MVI.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Evaluation Of Microvascular Invasion and Selection Of Postop...mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Postoperative adjuvant transarterial chemoembolisation improves survival of hepatocellular carcinoma patients with microvascular invasion: A multicenter retrospective cohort

et al. 2023

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Deep learning‐based accurate diagnosis and quantitative evaluation of microvascular invasion in hepatocellular carcinoma on whole‐slide histopathology images

Zhang,

Yu,

Liang

et al. 2024

Cancer Medicine

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BackgroundMicrovascular invasion (MVI) is an independent prognostic factor that is associated with early recurrence and poor survival after resection of hepatocellular carcinoma (HCC). However, the traditional pathology approach is relatively subjective, time‐consuming, and heterogeneous in the diagnosis of MVI. The aim of this study was to develop a deep‐learning model that could significantly improve the efficiency and accuracy of MVI diagnosis.Materials and MethodsWe collected H&E‐stained slides from 753 patients with HCC at the First Affiliated Hospital of Zhejiang University. An external validation set with 358 patients was selected from The Cancer Genome Atlas database. The deep‐learning model was trained by simulating the method used by pathologists to diagnose MVI. Model performance was evaluated with accuracy, precision, recall, F1 score, and the area under the receiver operating characteristic curve.ResultsWe successfully developed a MVI artificial intelligence diagnostic model (MVI‐AIDM) which achieved an accuracy of 94.25% in the independent external validation set. The MVI positive detection rate of MVI‐AIDM was significantly higher than the results of pathologists. Visualization results demonstrated the recognition of micro MVIs that were difficult to differentiate by the traditional pathology. Additionally, the model provided automatic quantification of the number of cancer cells and spatial information regarding MVI.ConclusionsWe developed a deep learning diagnostic model, which performed well and improved the efficiency and accuracy of MVI diagnosis. The model provided spatial information of MVI that was essential to accurately predict HCC recurrence after surgery.

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Development and validation of nomograms to evaluate the survival outcome of HCC patients undergoing selective postoperative adjuvant TACE

He,

Qian,

Zhu

et al. 2024

Radiol med

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A novel classification in predicting prognosis and guiding postoperative management after R0 liver resection for patients with hepatocellular carcinoma and microvascular invasion

Cited by 12 publications

References 37 publications

Postoperative adjuvant transarterial chemoembolisation improves survival of hepatocellular carcinoma patients with microvascular invasion: A multicenter retrospective cohort

Postoperative adjuvant transarterial chemoembolisation improves survival of hepatocellular carcinoma patients with microvascular invasion: A multicenter retrospective cohort

Deep learning‐based accurate diagnosis and quantitative evaluation of microvascular invasion in hepatocellular carcinoma on whole‐slide histopathology images

Development and validation of nomograms to evaluate the survival outcome of HCC patients undergoing selective postoperative adjuvant TACE

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