Predictive factors of pathological vascular invasion in hepatocellular carcinoma within 3 cm and three nodules without radiological vascular invasion

Masuda, Toshiro; Beppu, Teruhiko; Okabe, Hidetoshi; Nitta, Hidetoshi; Imai, Katsunori; Hayashi, Hiromitsu; Chikamoto, Akira; Yamamoto, Kenichiro; Ikeshima, Satoshi; Kuramoto, Masafumi; Shimada, Shinya; Baba, Hideo

doi:10.1111/hepr.12637

Cited by 15 publications

(18 citation statements)

References 39 publications

(45 reference statements)

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“…Yamashita et al demonstrated that not only the presence of microinvasion such as portal venous, hepatic vein, bile duct infiltration, but also the presence of intrahepatic metastasis (satellites) is the best indicator of a poor prognosis after HR and transplantation. Therefore, MI‐HCC may be considered an important entity (superior to the only presence of vascular microinfiltration) to determine the prognosis of patients submitted not only to HR or liver transplantation but also to ablation therapies . Our study showed that IOUS definition of MI‐HCC had a high agreement with the histological findings, such as the satellites detection and the correct measurement of HCC diameter (see Table ) and the type of IOUS examination (through either a laparoscopic or an open approach) did not influence these results (see Table ).…”

Section: Discussionsupporting

confidence: 49%

“…Therefore, MI-HCC may be considered an important entity (superior to the only presence of vascular microinfiltration) to determine the prognosis of patients submitted not only to HR or liver transplantation 4,7,36 but also to ablation therapies. [37][38][39] Our study showed that IOUS definition of MI-HCC had a high agreement with the histological findings, such as the satellites detection and the correct measurement of HCC diameter (see Table 3) and the type of IOUS examination (through either a laparoscopic or an open approach) did not influence these results (see Table 4). This analysis is also valid in the subgroup of patients with HCC diameter ≤2 cm (see Table 5).…”

Section: Discussionmentioning

confidence: 51%

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Intraoperative ultrasound for prediction of hepatocellular carcinoma biological behaviour: Prospective comparison with pathology

Santambrogio¹,

Claudia

Barabino³

et al. 2017

Liver International

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Background & Aims Preoperative prediction of both microinvasive hepatocellular carcinoma and histological grade of hepatocellular carcinoma is pivotal to treatment planning and prognostication. The aim of this study was to evaluate whether some intraoperative ultrasound features correlate with both the presence of same histological patterns and differentiation grade of hepatocellular carcinoma on the histological features of the primary resected tumour. Methods All patients with single, small hepatocellular carcinoma that underwent hepatic resection were included in this prospective double‐blind study: the intraoperative ultrasound patterns of nodule were registered and compared with similar histological features. Results A total of 179 patients were enclosed in this study: 97 (54%) patients (34% in HCC ≤2 cm) had a microinvasive hepatocellular carcinoma at ultrasound examination, while 82 (46%) patients (41% in HCC ≤2 cm) at histological evaluation. Statistical analysis showed that diameters ≤2 cm, presence of satellites and microinvasive hepatocellular carcinoma at ultrasound examination were the variables with the strongest association with the histological findings. In the multivariate analysis, the vascular microinfiltration and infiltrative hepatocellular carcinoma aspect were independent predictors for grading. Conclusions In patients with cirrhosis and hepatocellular carcinoma, the prevalence of microinvasive hepatocellular carcinoma is high, even in cases of HCC ≤2 cm. Intraoperative ultrasound findings strongly correlated with histopathological criteria in detecting microinvasive patterns and are useful to predict neoplastic differentiation. The knowledge of these features prior to treatment are highly desired (this can be obtained by an intraoperative ultrasound examination), as they could help in providing optimal management of patients with hepatocellular carcinoma.

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Section: Discussionsupporting

confidence: 49%

Section: Discussionmentioning

confidence: 51%

Intraoperative ultrasound for prediction of hepatocellular carcinoma biological behaviour: Prospective comparison with pathology

Santambrogio¹,

Claudia

Barabino³

et al. 2017

Liver International

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“…Many reports have noted the heterogeneity of small HCC ≤3 cm, and some of these tumors display microvascular invasion (MVI) ranging from 18.1% to 37.0%, which indicated locally advanced HCC . We previously reported that HR with a wide margin (>0.5 cm) led to better survival in patients with solitary HCC ≤2 cm that displayed MVI.…”

Section: Introductionmentioning

confidence: 99%

Microvascular invasion of single small hepatocellular carcinoma ≤3 cm: Predictors and optimal treatments

Yamashita

Imai

Yusa

et al. 2018

Annals of Gastroent Surgery

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BackgroundSmall hepatocellular carcinomas (HCC ≤3 cm) are generally considered to have low malignant potential; however, some of them display pathological microvascular invasion (MVI).MethodsBetween 1991 and 2013, 414 patients with a single HCC ≤3 cm underwent curative hepatic resection (HR). Predictors for MVI were identified. Using another cohort (149 patients during 2000‐2014), our predictors for MVI in HCC ≤3 cm were validated. In 428 patients with a single HCC ≤3 cm who had predictors for MVI, survival was compared among anatomical HR (n = 149), partial HR (n = 227), and radiofrequency ablation (RFA) (n = 52).ResultsThe positive rate of MVI reached 40.6% (168/414 patients). Independent predictors for MVI were as follows: tumor diameter ≥2 cm (odds ratio 1.84, P = .0052), alpha‐fetoprotein (AFP) ≥200 ng/mL (odds ratio 1.82, P = .0466), and des‐gamma‐carboxy prothrombin (DCP) ≥40 mAU/mL (odds ratio 1.79, P = .0126). Matching at least one predictor among these three could predict MVI in HCC ≤3 cm well (sensitivity 82.8%, positive predictive value [PPV] 48.7%). This criterion could also predict MVI in HCC ≤3 cm well in another cohort (sensitivity 82.8%, PPV 30.3%). In patients with single HCC ≤3 cm matching our criterion for predicting MVI, anatomical HR led to significantly better survival in both disease‐free (hazard ratio 0.689, P = .0231) and overall (hazard ratio 0.589, P = .0316) survivals.ConclusionMatching at least one factor among three (tumor diameter ≥2 cm, AFP ≥200 ng/mL, or DCP ≥40 mAU/mL) can predict MVI in HCC ≤3 cm. In such patients, anatomical HR would be recommended to improve survival.

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“…32 If RFA was inadequately applied for such tumors, abnormal recurrence, such as intrahepatic dissemination, can occur. 34,35 Therefore, for those patients, we should avoid RFA regardless of the patients' functional reserve.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment strategy for hepatocellular carcinoma in patients with impaired liver function: hepatic resection or radiofrequency ablation?

Yamao

Imai

Yamashita

et al. 2018

HPB

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Predictive factors of pathological vascular invasion in hepatocellular carcinoma within 3 cm and three nodules without radiological vascular invasion

Abstract: AFP of more than 100 ng/mL and PIVKA-II of more than 100 mAU/mL can predict pathological vascular invasion in patients with HCC within 3 cm and three nodules without radiological vascular invasion. In treating such cases, hepatic resection rather than local ablation therapy is recommended.

Cited by 15 publications

References 39 publications

Intraoperative ultrasound for prediction of hepatocellular carcinoma biological behaviour: Prospective comparison with pathology

Intraoperative ultrasound for prediction of hepatocellular carcinoma biological behaviour: Prospective comparison with pathology

Microvascular invasion of single small hepatocellular carcinoma ≤3 cm: Predictors and optimal treatments

Surgical treatment strategy for hepatocellular carcinoma in patients with impaired liver function: hepatic resection or radiofrequency ablation?

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