Predictors for Microinvasion of Small Hepatocellular Carcinoma ≤2 cm

Yamashita, Yo Ichi; Tsuijita, Eiji; Takeishi, Kazuki; Fujiwara, Megumu; Kira, Shinsuke; Mori, Masaki; Aishima, Shinichi; Taketomi, Akinobu; Shirabe, Ken; Ishida, Terutoshi; Maehara, Yoshihiko

doi:10.1245/s10434-011-2195-0

Cited by 131 publications

(140 citation statements)

References 36 publications

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“…AFP-L3 positivity and failure of AFP-L3 conversion to negativity or further elevation of AFP-L3 are associated with aggressive tumor behavior and worse histologic grade results in early tumor recurrence (i.e., in MVI) (28, 33). In a different study, DCP >100 mAU/mL was proposed as a reliable predictor for MVI even in small HCCs (≤2 cm), with a positive predictive value of 79.3% (34). They also reported that DCP was more specific than AFP for MVI (34).…”

Section: Tumor Markersmentioning

confidence: 97%

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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: Tumor Markersmentioning

confidence: 97%

“…In a different study, DCP >100 mAU/mL was proposed as a reliable predictor for MVI even in small HCCs (≤2 cm), with a positive predictive value of 79.3% (34). They also reported that DCP was more specific than AFP for MVI (34).…”

Section: Tumor Markersmentioning

confidence: 97%

Microvascular invasion in hepatocellular carcinoma

Ünal

İdilman

Akata³

et al. 2016

Diagn Interv Radiol

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“…But, the accuracy of DCP might be diminished in prolonged obstructive jaundice, intrahepatic cholestasis with vitamin K deficiency, and intake of warfarin and even some antibiotics [4]. Thirdly, DCP might be a better marker than AFP in detecting early stage of HCC with tumors smaller than 2 cm [4,59]. Fourthly, the half-life of plasma DCP around 40-72 hours is much shorter than that of AFP around 5-7 days.…”

Section: The Significance and Marker For Hcc Diagnosismentioning

confidence: 99%

Des-γ-Carboxy Prothrombin (DCP) as a Potential Autologous Growth Factor for the Development of Hepatocellular Carcinoma

Zhang

Chu

Cui

et al. 2014

Cell Physiol Biochem

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Des-γ-carboxy prothrombin (DCP) is a prothrombin precursor produced in hepatocellular carcinoma (HCC). Because of deficiency of vitamin K or γ-glutamyl carboxylase in HCC cells, the 10 glutamic acid (Glu) residues in prothrombin precursor did not completely carboxylate to γ-carboxylated glutamic acid (Gla) residues, leaving some Glu residues remained in N-terminal domain. These prothrombin precursors with Glu residues are called DCPs. DCP displays insufficient coagulation activity. Since Liebman reported an elevated plasma DCP in patients with HCC, DCP has been used in the diagnosis of HCC. Recently, its biological malignant potential has been specified to describe DCP as an autologous growth factor to stimulate HCC growth and a paracrine factor to integrate HCC with vascular endothelial cells. DCP was found to stimulate HCC growth through activation of the DCP-Met-JAK1-STAT3 signaling pathway. DCP might increase HCC invasion and metastasis through activation of matrix metalloproteinase (MMPs) and the ERK1/2 MAPK signaling pathway. DCP has also been found to play a crucial role in the formation of angiogenesis. DCP could increase the angiogenic factors released from HCC and vascular endothelial cells. These effects of DCP in angiogenesis might be related to activation of the DCP-KDR-PLC-γ-MAPK signaling pathway. In this article, we summarized recent studies on DCP in biological roles related to cancer progression and angiogenesis in HCC.

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“…In Table 1, laboratory data, imaging data, and pathological data have identified some indicators as risk factors of prognosis for sufferers with HCC (12)(13)(14)(15). Microvascular invasion (MVI), tumor size, and tumor number indicated in imaging data are considered as risk factors for prognosis.…”

Section: Ggt As a Predictive Biomarker In Clinical Investigationsmentioning

confidence: 99%

Advances of diagnostic and mechanistic studies of γ-glutamyl transpeptidase in hepatocellular carcinoma

Xia

Song

Sun

et al. 2016

DD&T

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Predictors for Microinvasion of Small Hepatocellular Carcinoma ≤2 cm

Abstract: Even in cases of HCC ≤ 2 cm, patients who are suspected of having invasive gross type tumors in preoperative imaging diagnosis or who have a high DCP level (>100 mAU/ml) are at risk for MI. Therefore, in such patients, hepatic resection with a wide tumor margin should be recommended.

Cited by 131 publications

References 36 publications

Microvascular invasion in hepatocellular carcinoma

Microvascular invasion in hepatocellular carcinoma

Des-γ-Carboxy Prothrombin (DCP) as a Potential Autologous Growth Factor for the Development of Hepatocellular Carcinoma

Advances of diagnostic and mechanistic studies of γ-glutamyl transpeptidase in hepatocellular carcinoma

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Predictors for Microinvasion of Small Hepatocellular Carcinoma ≤2 cm

Abstract: Even in cases of HCC ≤ 2 cm, patients who are suspected of having invasive gross type tumors in preoperative imaging diagnosis or who have a high DCP level (>100 mAU/ml) are at risk for MI. Therefore, in such patients, hepatic resection with a wide tumor margin should be recommended.

Cited by 131 publications

References 36 publications

Microvascular invasion in hepatocellular carcinoma

Microvascular invasion in hepatocellular carcinoma

Des-&#947;-Carboxy Prothrombin (DCP) as a Potential Autologous Growth Factor for the Development of Hepatocellular Carcinoma

Advances of diagnostic and mechanistic studies of γ-glutamyl transpeptidase in hepatocellular carcinoma

Contact Info

Product

Resources

About

Des-γ-Carboxy Prothrombin (DCP) as a Potential Autologous Growth Factor for the Development of Hepatocellular Carcinoma