Can microvessel invasion of hepatocellular carcinoma be predicted by pre-operative MRI?

Kim, Honsoul; Park, Mi‐Suk; Choi, Jin Young; Park, Young Nyun; Kim, Do Young; Kim, Kyung Sik; Choi, Jin Sub; Han, Kwang‐Hyub; Kim, EunJu; Kim, Ki Whang

doi:10.1007/s00330-009-1331-8

Cited by 161 publications

(143 citation statements)

References 19 publications

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“…They reported that wedge-shaped enhancement could be due to nontumorous arterioportal shunts rather than tumorous ones and it was not a statistically significant risk factor for MVI; on the other hand, irregular circumferential peritumoral enhancement could be a preoperative predictor of MVI. The sensitivity, specificity, positive predictive value, and negative predictive value of irregular circumferential peritumoral enhancement in the prediction of MVI were 74.3%, 82.9%, 81.3%, and 76.3%, respectively (16). The crucial point in their study was obtaining four arterial-phase MRI scans at the same level.…”

Section: Peritumoral Enhancementmentioning

confidence: 98%

“…They also reported that the presence of an intact capsule on CT was closely correlated with the absence of MVI (13). In a different study authors reported that there was no significant correlation between MVI and presence of radiologic capsule (16). On the other hand, Adachi et al (17) reported that a fibrous capsule was a predictor of portal venous invasion since cancer cells frequently invade the vessels of the fibrous capsule.…”

Section: Capsulementioning

confidence: 99%

“…However, the latter two studies did not clarify the phase that was used for capsule assessment. Capsule enhancement may occur on all phases according to its vascularity; thus, early enhancement of the capsule cannot be distinguished from peritumoral enhancement (16). Similarly, Ariizumi et al (19) reported that there were no clinical or magnetic resonance imaging (MRI) findings to predict MVI, except for the radiologic capsule on dynamic studies and nonsmooth tumor margin on axial hepatobiliary phase (Fig.…”

Section: Capsulementioning

confidence: 99%

“…There was statistically significant correlation between the peritumoral enhancement and MVI on the third arterial phase (P = 0.004). They argued that the ability of single arterial phase image to evaluate peritumoral enhancement was inadequate compared with multiarterial phase images and suggested that peritumoral enhancement could be estimated more accurately with a multiarterial phase study (16). In a different study, Chou et al (20) reported that peritumoral enhancement on multiphasic CT was not a significant risk factor for MVI.…”

Section: Peritumoral Enhancementmentioning

confidence: 99%

“…Therefore, hepatobiliary phase images should be used for accurate results (16). Tumor size showed statistically significant association with the presence of MVI in several studies (16,20,27,28) (26) found no significant correlation between tumor size and microvascular invasion, but they emphasized that this contradiction might be due to patient selection bias with a mean tumor size of 2.1 cm (26).…”

Section: Tumor Sizementioning

confidence: 99%

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Microvascular invasion in hepatocellular carcinoma

Ünal

İdilman

Akata³

et al. 2016

Diagn Interv Radiol

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H epatocellular carcinoma (HCC) is responsible for high incidence of cancer-related mortality worldwide (1, 2). Diagnosis of HCC is a well-known topic, and now it can be made solely by imaging findings in cirrhosis (3,4). Advances in imaging procedures and intense follow-up of high-risk patients led to increased early detection of HCC and better treatment options (5, 6). However, even in good surgical candidates, long-term survival rates remain unsatisfactory because of high recurrence (7,8). Presence of microvascular invasion (MVI) has been reported to be one of the most important risk factors related to postsurgery tumor recurrence (9-11). Presence of MVI alters the surgical procedure. MVI is a prognostic factor associated with lower survival and higher recurrence rates. Prediction of MVI may also affect locoregional treatments along with chemotherapy protocols. This review will focus on all aspects of MVI. The effect of microvascular invasion on survivalEarly tumor recurrence is linked to increased mortality rate. Lim et al. (9) reported that MVI is a more prominent tumor recurrence predictor than the Milan criteria for HCC after surgical resection. The patients who fulfill the Milan criteria should have a solitary tumor not exceeding 5 cm or three or fewer tumors with the largest not exceeding 3 cm, and no evidence of macrovascular invasion or extrahepatic metastasis (5, 9). Lim et al. (9) concluded that patients (without MVI) exceeding the Milan criteria could achieve comparable overall survival rates after surgical resection, relative to patients within the Milan criteria. However, overall survival decreased significantly with MVI, independently of the Milan criteria.In a different study, authors grouped the patients into mild (one to five invaded vessels) and severe (more than five invaded vessels) MVI groups (5). They found that the three-year recurrence-free survival rates for patients with and without MVI were 27.7% and 62.5%, respectively. They also reported that recurrence-free survival rates at two years for patients without MVI, with mild MVI, and severe MVI were 75.9%, 47.2%, and 32.7%, respectively (5). Goh et al. (12) studied patients who had surgical resection of multifocal HCC and revealed that the presence of MVI and the number of nodules (which is also a result of MVI) were more important prognostic factors than tumor size (12). They also suggested that the current American Joint Committee for Cancer TNM staging system, which uses tumor size, but not MVI, as prognostic criteria for multifocal HCC, needs to be revised (12). The indicators of microvascular invasionDespite its significance in HCC assessment, MVI can rarely be diagnosed preoperatively. However, the presence of MVI may be predicted by key radiologic findings and specific lab- We reviewed the literature and aimed to draw attention to clinicopathologic and imaging findings that may predict the presence of microvascular invasion in hepatocellular carcinoma. Imaging findings suggesting microvascular invasion are disruption of capsule...

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Section: Peritumoral Enhancementmentioning

confidence: 98%

Section: Capsulementioning

confidence: 99%

Section: Capsulementioning

confidence: 99%

Section: Peritumoral Enhancementmentioning

confidence: 99%

Section: Tumor Sizementioning

confidence: 99%

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Microvascular invasion in hepatocellular carcinoma

Ünal

İdilman

Akata³

et al. 2016

Diagn Interv Radiol

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Hepatectomy versus radiofrequency ablation for early-stage hepatocellular carcinoma

Fujita

2011

Hepatology

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We read with great interest the report by Montes-Cano et al. 1 in a recently published issue of Hepatology. They found different rates of hepatitis C virus (HCV) genotype distribution with respect to an interleukin-28B variant in Spanish individuals. The authors noted that the rs12979860 wild CC genotype, an independent predictor favoring a sustained virological response to peginterferon/ribavirin, was overrepresented among patients with a non-1 HCV genotype (HCV-non-1) versus hepatitis C virus genotype 1 (HCV-1)-infected patients (66.7% versus 39.1%, P < 0.001). However, the results require confirmation in a larger cohort and especially in Asian populations, in which HCV-non-1 is much more prevalent. To clarify the issue, we analyzed a large cohort in southern Taiwan, in which HCV infections are endemic 2 ; more than 40% of the patients were infected with HCV-2. 3 In all, 1005 patients were tested for associations between HCV characteristics and host genetic variants of rs8099917, a novel single nucleotide polymorphism that has a tremendous impact on the response to interferon-based therapy. For patients of Asian ethnicity, the carriage of the rs8099917 TT genotype could enhance the treatment outcomes of HCV-1 infection 4 and improve the early viral kinetics of HCV-2 infection. 5 With respect to the viral genotypes, 552 of the patients (54.9%) were infected with HCV-1, and 453 patients (45.1%) were infected with HCV-non-1 (43.4% with HCV-2, 0.1% with HCV-3, and 1.6% with an unclassified genotype). When patients were stratified according to their rs8099917 genotypes (TT versus TG/GG), the TT genotype was overrepresented among HCV-non-1-infected patients versus HCV-1 patients (91.4% versus 85.0%, P ¼ 0.002; Table 1). Multivariate logistic regression analysis demonstrated that HCV-1 infection and baseline HCV RNA levels were independent factors negatively associated with the carriage of the rs8099917 TT genotype with odds ratios of 0.58 (95% confidence interval ¼ 0.382-0.873, P ¼ 0.009) and 0.81 (95% confidence interval ¼ 0.652-0.997, P ¼ 0.047), respectively. Our findings were in agreement with Montes-Cano and et al.'s discovery that HCV-1 patients carry a higher rate of unfavorable alleles that might compromise treatment responses. In addition, the frequency of the rs8099917 TT genotype in our study (88%) was substantially higher than that reported in Swiss Caucasians (58%), 6 and this was in line with the finding that Asian populations had the highest rs12979860 C allelic frequency. 7 The host genotype-specific selection of the viral genotype may contribute to the higher proportion of HCV-non-1 distribution in Asian areas. 3 The divergence of the host genetic predisposition among patients with different HCV genotypes and ancestries might in part explain the substantially higher sustained virological response rates in Asian patients receiving peginterferon/ribavirin. 8,9 The real cause is not clear; it is postulated that there exists a selection pressure between the HCV viral genotype and host immune respon...

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Expression and prognostic significance of placental growth factor in hepatocellular carcinoma and peritumoral liver tissue

Zhu

Zhuang

et al. 2011

Intl Journal of Cancer

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Vascular endothelial growth factor‐targeted therapy is a promising treatment for hepatocellular carcinoma (HCC), but its clinical benefit is often accompanied by acquired resistance. In animal studies, antiplacental growth factor therapy is effective with less resistance. The role of placental growth factor (PlGF) in the progression of HCC is not clear. In our study, we used immunohistochemistry in tissue microarrays to investigate PlGF expression in tumor and peritumoral liver tissues from 105 patients with HCC. Intratumoral and peritumoral PlGF mRNA expression was analyzed in another cohort of 37 patients. Peritumoral PlGF expression was significantly higher than intratumoral PlGF expression (p < 0.001). Intratumoral PlGF expression was not associated with patients' overall survival (OS) or time to recurrence (TTR). However, peritumoral PlGF expression, which was associated with tumor size, presence of intrahepatic metastasis, TNM stage and Barcelona Clinic Liver Cancer stage, was an independent risk factor for OS (p = 0.026) and TTR (p = 0.041). The prognostic value of peritumoral PlGF expression was further validated in a validation cohort (n = 394). We inferred that the elevation of PlGF in peritumoral liver might be induced by hypoxia. We found that peritumoral PlGF expression was associated with hypoxia‐inducible factor‐1α (p = 0.017). PlGF expression was elevated in L02, a hepatic cell line, under hypoxic conditions in vitro. These findings indicate that high peritumoral PlGF expression is associated with tumor recurrence and survival after resection of HCC. PlGF could be a target of adjuvant therapy and deserves further investigations.

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Can microvessel invasion of hepatocellular carcinoma be predicted by pre-operative MRI?

Cited by 161 publications

References 19 publications

Microvascular invasion in hepatocellular carcinoma

Microvascular invasion in hepatocellular carcinoma

Hepatectomy versus radiofrequency ablation for early-stage hepatocellular carcinoma

Expression and prognostic significance of placental growth factor in hepatocellular carcinoma and peritumoral liver tissue

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