New scoring system for prediction of microvascular invasion in patients with hepatocellular carcinoma

Shirabe, Ken; Toshima, Takeo; Kimura, Koichi; Yamashita, Yo‐ichi; Ikeda, Tetsuo; Ikegami, Toru; Yoshizumi, Tomoharu; Abe, Koichiro; Aishima, Shinichi; Maehara, Yoshihiko

doi:10.1111/liv.12459

Cited by 82 publications

(65 citation statements)

References 23 publications

(42 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However AFP appears more sensitive than PIVKA-Ⅱ for early HCC [49] . Increased serum PIVKA-Ⅱ concentrations are found in patients with more advanced HCC, and in patients with mVI [50][51][52] . The combination of PIVKA-Ⅱ and AFP provided increased accuracy than any of them alone [53] .…”

Section: Namentioning

confidence: 96%

Strategies to improve outcome of patients with hepatocellular carcinoma receiving a liver transplantation

Guerrero-Misas

Rodríguez‐Perálvarez

Mata

2015

WJH

View full text Add to dashboard Cite

Liver transplantation is the only therapeutic option which allows to treat both, the hepatocellular carcinoma and the underlying liver disease. Indeed, liver transplantation is considered the standard of care for a subset of patients with cirrhosis and hepatocellular carcinoma.However, tumour recurrence rates are as high as 20%, and once the recurrence is established the therapeutic options are scarce and with little impact on prognosis. Strategies to minimize tumour recurrence and thus to improve outcome may be classified into 3 groups: (1) An adequate selection of candidates for liver transplantation by using the Milan criteria; (2) An optimized management within waiting list including prioritization of patients at high risk of tumour progression, and the implementation of bridging therapies, particularly when the expected length within the waiting list is longer than 6 mo; and (3) Tailored immunosuppression comprising reduced exposure to calcineurin inhibitors, particularly early after liver transplantation, and the addition of mammalian target of rapamycin inhibitors. In the present manuscript the available scientific evidence supporting these strategies is comprehensively reviewed, and future directions are provided for novel research approaches, which may contribute to the final target: to cure more patients with hepatocellular carcinoma and with an improved long term outcome. Core tip: Liver transplantation is the only therapeutic option which allows to treat both, the hepatocellular carcinoma and the underlying liver disease. However, tumour recurrence rates are 15%-20% with a very poor prognosis. Strategies to minimize tumour recurrence and thus to improve outcome are focused in a careful selection of candidates for liver transplantation, an optimized management within waiting list and a tailored immunosuppression. The available scientific evidence supporting these strategies is reviewed, and future directions are provided for novel research approaches, which may contribute to the final target: to cure more REVIEW Submit a

show abstract

Section: Namentioning

confidence: 96%

Strategies to improve outcome of patients with hepatocellular carcinoma receiving a liver transplantation

Guerrero-Misas

Rodríguez‐Perálvarez

Mata

2015

WJH

View full text Add to dashboard Cite

show abstract

“…It is known that AFP-L3 form is not proportional to AFP; thus, it can be used as an inMicrovascular invasion in hepatocellular carcinoma • 129 dependent and significant factor for diagnosis of HCC, and it is associated with tumor aggressiveness (28, 32). Shirabe et al (36) designed a scoring system using tumor size, serum DCP levels, and values of SUV max to predict MVI. They reported that when the tumor size is ≥3.6 cm, SUV max ≥4.2, and the serum DCP level ≥101 mAU/mL, MVI can be predicted precisely with a sensitivity of 100% and specificity of 90.9% (36).…”

Section: Tumor Markersmentioning

confidence: 99%

“…Shirabe et al (36) designed a scoring system using tumor size, serum DCP levels, and values of SUV max to predict MVI. They reported that when the tumor size is ≥3.6 cm, SUV max ≥4.2, and the serum DCP level ≥101 mAU/mL, MVI can be predicted precisely with a sensitivity of 100% and specificity of 90.9% (36).…”

Section: Tumor Markersmentioning

confidence: 99%

Microvascular invasion in hepatocellular carcinoma

Ünal

İdilman

Akata³

et al. 2016

Diagn Interv Radiol

View full text Add to dashboard Cite

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...

show abstract

“…In contrast, HCC does not recur in diverse patients who undergo transplantation on the basis of expanded criteria beyond the Milan criteria, such as preoperative radiologic findings other than the two main determinants of cancer recurrence (poor tumor grade and microvascular invasion) [5]. However, morphological data based mainly on tumor size and number of nodules are imperfect in predicting the behavior of HCC after LT.…”

Section: Introductionmentioning

confidence: 99%

Glutamate Dehydrogenase and Alkaline Phosphatase as Very Early Predictors of Hepatocellular Carcinoma Recurrence after Liver Transplantation

Piras-Straub

Khairzada²,

Gerken³

et al. 2015

Digestion

View full text Add to dashboard Cite

Background: Although long-term survival rates for patients undergoing liver transplant (LT) for hepatocellular carcinoma (HCC) are good, the relatively high rate of tumor recurrence after LT necessitates the identification of biological parameters that supplement morphological predictors of recurrence. Method: From chart review we identified 175 patients who received liver transplantation due to HCC at our center between January 2000 and December 2013. We documented demographic and clinical data, as well as clinicopathological characteristics of the tumors, with a focus on liver values at the time of LT. Results: HCC recurred in 23% of LT patients. Most recurrences (59%) occurred within 12 months after LT; hardly any recurrence was detected later than 3 years after LT. Recurrence was positively correlated with tumor size, tumor stage and alpha-fetoprotein level (AFP), and it was most likely with certain causes of liver disease. Interestingly, tumor recurrence was independently predicted by serum levels of glutamate dehydrogenase (GLDH) and alkaline phosphatase (AP) at the time of LT. Conclusions: Because all HCC recurrence occurs within 36 months after LT, HCC detected more than 3 years after LT may be considered de novo. Liver values, with GLDH and AP being the most preponderant, serve as easy-to-assess biomarkers which contribute to predict the risk of tumor recurrence.

show abstract

New scoring system for prediction of microvascular invasion in patients with hepatocellular carcinoma

Abstract: Our scoring system for mvi, consisting of tumour size, serum DCP levels, and SUV max, provides a precise prediction of mvi.

Cited by 82 publications

References 23 publications

Strategies to improve outcome of patients with hepatocellular carcinoma receiving a liver transplantation

Strategies to improve outcome of patients with hepatocellular carcinoma receiving a liver transplantation

Microvascular invasion in hepatocellular carcinoma

Glutamate Dehydrogenase and Alkaline Phosphatase as Very Early Predictors of Hepatocellular Carcinoma Recurrence after Liver Transplantation

Contact Info

Product

Resources

About