Factors Affecting Local and Intra Hepatic Distant Recurrence After Surgery for Hcc: An Alternative Perspective on Microvascular Invasion and Satellitosis – A Western European Multicentre Study

Famularo, Simone; Piardi, Tullio; Molfino, Sarah; Martino, Marcello Di; Ferrari, Cecilia; Ielpo, Benedetto; Diago, M.V.; Giani, Alessandro; Griseri, G.; Terés, Lara Bianco; Gianotti, Luca; Baiocchi, Gian Luca; Sommacale, Danièle; Romano, Fabrizio

doi:10.1007/s11605-019-04503-7

Cited by 15 publications

(9 citation statements)

References 40 publications

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“…Many researchers have reported that MVIs are often found in the postoperative pathological examination of HCC patients. The presence of MVI reflects the ability of the tumor to invade and metastasize, and it is also a significant factor for poor postoperative prognosis [24–30]. MVI was also found to be an important factor affecting the postoperative prognosis of patients with rHCC in an ongoing study by our team.…”

Section: Discussionmentioning

confidence: 96%

A nomogram for preoperative prediction of microvascular invasion in ruptured hepatocellular carcinoma

Xia

Zhang

Ndhlovu

et al. 2023

European Journal of Gastroenterology &Amp; Hepatology

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Background and aim Microvascular invasion (MVI) is defined as the presence of micrometastatic cancer cell emboli in hepatic vessels, including small vessels, and at present, researchers believe that is an important factor for early postoperative recurrence and survival. Here, we developed and validated a preoperative predictive model for the presence of MVI in patients with ruptured hepatocellular carcinoma (rHCC). Methods We retrospectively collected data for 210 rHCC patients who underwent staged hepatectomy at Wuhan Tongji Hospital, and 91 patients who underwent staged hepatectomy at Zhongshan People’s Hospital between January 2010 and March 2021. Then, the former was used as the training cohort and the latter was used as the validation cohort. Logistic regression was used to screen for variables associated with MVI, and these variables were used to construct nomograms. We used R software to assess the discrimination, calibration ability, as well as clinical efficacy of nomograms. Results Multivariate logistic regression analysis identified four risk factors independently associated with MVI: max tumor length [odds ratio (OR) = 1.385; 95% confidence interval (CI), 1.072–1.790], number of tumors (OR = 2.182; 95% CI, 1.129–5.546), direct bilirubin (OR = 1.515; 95% CI, 1.189–1.930), and alpha-fetoprotein (cutoff = 400 ng/mL) (OR = 2.689; 95% CI, 3.395–13.547). Nomograms were built from the four variables and they were tested for discrimination and calibration, and the results were good. Conclusion We developed and validated a preoperative predictive model for the presence of MVI in patients with ruptured HCC. This model can help clinicians identify patients at risk of MVI and make better treatment options.

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Section: Discussionmentioning

confidence: 96%

A nomogram for preoperative prediction of microvascular invasion in ruptured hepatocellular carcinoma

Xia

Zhang

Ndhlovu

et al. 2023

European Journal of Gastroenterology &Amp; Hepatology

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“…Additionally, tumor satellite focus is an independent risk factor for OS and RFS in patients with HCC following hepatectomy. Reports indicate that tumor satellite focus are distant intrahepatic recurrence predictors and possible markers of advanced systemic disease [ 40 ]. Some studies have also reported that portal vein tumor thrombus and AFP levels are influential factors for OS and disease-free survival (DFS) [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

Effects of Clonorchis sinensis combined with Hepatitis B virus infection on the prognosis of patients with Hepatocellular Carcinoma following Hepatectomy

Zhao

Yang

et al. 2023

PLoS Negl Trop Dis

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Background This study aimed to determine the impact of co-infection of Clonorchis sinensis (CS) and hepatitis B virus (HBV) on the prognosis of patients with hepatocellular carcinoma (HCC) following hepatectomy. Methods The clinicopathological information of 946 patients with HCC following hepatectomy was retrospectively analyzed. The patients were divided into four groups depending on whether they had CS infection and/or HBV infection: double-negative group (infected with neither CS nor HBV), simple CS group (infected with only CS), simple HBV group (infected with only HBV), and double-positive group (co-infected with CS and HBV). Kaplan-Meier curves were used to evaluate the overall survival (OS) and recurrence-free survival (RFS), while log-rank tests were used to compare survival rates. Further, Cox regression was used to perform both univariate and multivariate survival analyses to identify variables linked to the prognosis of HCC. Results The median overall survival (OS) and recurrence-free survival (RFS) in the double-positive, simple CS, simple HBV, and double-negative groups were 27 months and 9 months, 20 months and 7 months, 44 months and 12 months, and 42 months and 17 months, respectively. The double-positive group’s 1-year, 3-year, and 5-year OS and RFS rates were 79.2% and 46.9%, 62.6% and 28.4%, 47.8%, and 12.2%, respectively. The simple CS group’s 1-year, 3-year, and 5-year OS and RFS rates were 86.3% and 41.5%, 56.5% and 27.7%, 50.2%, and 18.5%, respectively. The simple HBV group’s 1-year, 3-year, and 5-year OS and RFS rates were 89.8% and 56.0%, 72.5% and 30.5%, 63.8%, and 19.9%, respectively. The double-negative group’s 1-year, 3-year, and 5-year OS and RFS rates were 91.5% and 62.3%, 76.1% and 32.9%, 64.0%, and 22.4%, respectively. Further, according to a Cox multivariate analysis, tumor size (> 5cm), Edmonson grade (III-IV), BCLC-C stage, and tumor satellite focus were independent risk factors for RFS and OS in patients with HCC. Conclusion Patients with HCC and Clonorchis sinensis infection experience a poor prognosis after hepatectomy, regardless of whether they are co-infected with HBV.

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“…Thus, the highest rate of intra-hepatic recurrence occurred in other liver segments than the one carrying the primitive nodule, suggesting a different or at least a concomitant route of the tumour cells. More recently, we tried to identify the risk factors for either local or intra-hepatic distant recurrence in a large European series[ 19 ], observing that local relapse occurred frequently in cases of positive surgical margin (and consequently as a kind of surgical failure), while the presence of microvascular invasion and satellitosis were hallmarks of increased risk of intra-hepatic distant relapse. These data suggest that, when those histological features occurred, the tumour may have already invaded the blood circulation, with a metastasisation potential in other locations that may not be explained by the local portal flow, and that cannot be controlled by modifying the extent of surgery.…”

Section: Reconsidering the Route Of Recurrence: Evidence-driven Hypothesismentioning

confidence: 99%

Finding the seed of recurrence: Hepatocellular carcinoma circulating tumor cells and their potential to drive the surgical treatment

Carissimi¹,

Barbaglia²,

Salmi³

et al. 2021

WJGS

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The treatment for hepatocellular carcinoma (HCC) relies on liver resection, which is, however, burdened by a high rate of recurrence after surgery, up to 60% at 5 years. No pre-operative tools are currently available to assess the recurrence risk tailored to every single patient. Recently liquid biopsy has shown interesting results in diagnosis, prognosis and treatment allocation strategies in other types of cancers, since its ability to identify circulating tumor cells (CTCs) derived from the primary tumor. Those cells were advocated to be responsible for the majority of cases of recurrence and cancer-related deaths for HCC. In fact, after being modified by the epithelial-mesenchymal transition, CTCs circulate as “seeds” in peripheral blood, then reach the target organ as dormant cells which could be subsequently “awakened” and activated, and then initiate metastasis. Their presence may justify the disagreement registered in terms of efficacy of anatomic vs non-anatomic resections, particularly in the case of microvascular invasion, which has been recently pointed as a histological sign of the spread of those cells. Thus, their presence, also in the early stages, may justify the recurrence event also in the contest of liver transplant. Understanding the mechanism behind the tumor progression may allow improving the treatment selection according to the biological patient-based characteristics. Moreover, it may drive the development of novel biological tailored tests which could address a specific patient to neoadjuvant or adjuvant strategies, and in perspective, it could also become a new method to allocate organs for transplantation, according to the risk of relapse after liver transplant. The present paper will describe the most recent evidence on the role of CTCs in determining the relapse of HCC, highlighting their potential clinical implication as novel tumor behavior biomarkers able to influence the surgical choice.

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Factors Affecting Local and Intra Hepatic Distant Recurrence After Surgery for Hcc: An Alternative Perspective on Microvascular Invasion and Satellitosis – A Western European Multicentre Study

Cited by 15 publications

References 40 publications

A nomogram for preoperative prediction of microvascular invasion in ruptured hepatocellular carcinoma

A nomogram for preoperative prediction of microvascular invasion in ruptured hepatocellular carcinoma

Effects of Clonorchis sinensis combined with Hepatitis B virus infection on the prognosis of patients with Hepatocellular Carcinoma following Hepatectomy

Finding the seed of recurrence: Hepatocellular carcinoma circulating tumor cells and their potential to drive the surgical treatment

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