Importance of Microvascular Invasion Risk and Tumor Size on Recurrence and Survival of Hepatocellular Carcinoma After Anatomical Resection and Non-anatomical Resection

Abstract

Purpose: To establish a valid prediction model to prognose the occurrence of microvascular invasion (MVI), and to compare the efficacy of anatomic resection (AR) or non-anatomic resection (NAR) for hepatocellular carcinoma (HCC).Methods: Two hundred twenty-eight patients with HCC who underwent surgical treatment were enrolled. Their hematological indicators, MRI imaging features, and outcome data were acquired.Result: In the multivariable analysis, alpha-fetoprotein >15 ng/mL, neutrophil to lymphocyte ratio >3.8, corona enhancement, and peritumoral hypointensity on hepatobiliary phase were associated with MVI. According on these factors, the AUROC of the predictive model in the primary and validation cohorts was 0.884 (95% CI: 0.829, 0.938) and 0.899 (95% CI: 0.821, 0.967), respectively. Patients with high risk of MVI or those with low risk of MVI but tumor size >5 cm in the AR group were associated with a lower rate of recurrence and death than patients in the NAR group; however, when patients are in the state of low-risk MVI with tumor size >5 cm, there is no difference in the rate of recurrence and death between AR and NAR.Conclusion: Our predictive model for HCC with MVI is convenient and accurate. Patients with high-risk of MVI or low-risk of MVI but tumor size >5 cm executing AR is of great necessity.

A Novel Clinically Prognostic Stratification Based on Prognostic Nutritional Index Status and Histological Grade in Patients With Gallbladder Cancer After Radical Surgery

“…Our study demonstrated that the GBC patients with PNI < 45.88 were associated with a poor prognosis (AUC = 0.947; sensitivity, 0.767; and specificity, 0.958). In previous studies, the maximum tumor diameter (MTD more than 5 mm) has also been identified as a very important risk factor for poor prognosis for patients with primary hepatic carcinoma ( 28 ). The most likely reason is that the larger MTD is usually associated with capsular invasion, non-invasive growth patterns, satellite nodules, or tumor thrombi ( 29 – 31 ).…”

Microvascular Invasion in Hepatocellular Carcinoma: A Review of Its Definition, Clinical Significance, and Comprehensive Management

“…Unfortunately, these two studies did not perform subgroup analyses according to tumour size. Recently, Hu et al performed an interesting study [ 62 ]. First, they established and verified the prediction model of MVI for HCC patients.…”

MVI-Mind: A Novel Deep-Learning Strategy Using Computed Tomography (CT)-Based Radiomics for End-to-End High Efficiency Prediction of Microvascular Invasion in Hepatocellular Carcinoma

“…Several studies have shown that MVI is an independent factor for postoperative tumor-free survival, and it can be used to effectively predict intrahepatic metastasis, multi-nodular recurrence, and can significantly reduce survival [ 14 , 15 , 16 ]. Adequate surgical margins such as anatomical resection are an important methods for reducing postoperative recurrence rates, which allow complete resection of the tumor-bearing portal vein branches, resulting in more efficient eradication of intrahepatic MVI [ 17 , 18 ]. However, a large amount of liver tissue needs to be removed during the operation, which leads to a high possibility of postoperative liver insufficiency.…”