The importance of a nonsmooth tumor margin and incomplete tumor capsule in predicting HCC microvascular invasion on preoperative imaging examination: a systematic review and meta-analysis

Song, Ling; Li, Jiawu; Luo, Yan

doi:10.1016/j.clinimag.2020.11.057

“…(2) Incomplete capsule is a risk factor for the failure of radiofrequency ablation combined with hepatic artery intervention in the treatment of patients with recurrence of primary liver cancer. e envelope of liver cancer refers to the extracellular matrix produced by avascular necrosis of the surrounding tissues due to the growth of the tumor [13,14]. Studies have shown that [15] when the diameter of a patient's tumor is greater than 5 cm, the capsule is a protective factor for the patient's therapeutic effect.…”

Section: Discussionmentioning

confidence: 99%

“…(3) Intrahepatic diffusion is a risk factor for the ineffectiveness of radiofrequency ablation combined with hepatic artery intervention in the treatment of patients with recurrence of primary liver cancer. e diffusion and metastasis of intrahepatic tumor in patients may lead to the failure of the lesion to be cleared during the treatment process and the infiltration of intrahepatic blood vessels by HCC cells [13], resulting in poor efficacy of radiofrequency ablation combined with hepatic artery intervention in the treatment of patients with postoperative recurrence of primary liver cancer. erefore, when locating the tumor location of a patient, medical staff should carefully observe whether the patient has the possibility of intrahepatic metastasis of liver cancer cells [18].…”

Section: Discussionmentioning

confidence: 99%

Effect of Radiofrequency Ablation with Interventional Therapy of Hepatic Artery on the Recurrence of Primary Liver Cancer and the Analysis of Influencing Factors

Zhang

¹

,

Zhao

²

,

Dong

³

2021

Journal of Oncology

5

1

0

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Background. The probability of liver cancer recurring in patients after surgery is a serious threat to liver cancer patients. Radiofrequency ablation is widely employed in liver cancer cases. We explored the therapeutic effects and influencing factors of radiofrequency ablation combined with hepatic artery intervention in patients with recurrence of primary liver cancer surgery. Methods. 90 patients with primary liver cancer postoperative recurrence admitted to our hospital from January 2014 to February 2017 were selected as the research objects. The patients were randomly divided into the control group (n = 45) and combined treatment group (n = 45). The combined treatment group received radiofrequency ablation combined with hepatic artery interventional therapy, and the control group received hepatic artery interventional therapy. The short-term efficacy, AFP levels before and after treatment, and long-term survival results of the two groups were compared. Single-factor and multifactor analyses of the clinical information of the combined treatment group were carried out to find out the factors affecting the therapeutic effect of radiofrequency ablation combined with hepatic artery intervention on patients with recurrence of primary liver cancer. Results. The total effective rate of short-term curative effect of the combined treatment group was higher than the control group, and there was a statistically significant difference existing ( P < 0.05). After treatment, two groups of patients’ AFP levels were greatly lower than before treatment, the AFP levels of the combined treatment group were significantly lower than the control group, and there was a statistically significant difference ( P < 0.05). The survival rates of patients in the combined treatment group at the sixth month, the first year, and the second year after treatment were significantly higher than those of the control group, and there was a statistically significant difference ( P < 0.05). The univariate results showed that, in the combined treatment group, there were statistically significant differences between the effective group and the ineffective group in tumor diameter, intact capsule, liver cirrhosis, intrahepatic spread, and tumor adjacent to large blood vessels ( P < 0.05). The outcomes of multivariate analysis indicated that tumor diameter ≥ 3 cm, incomplete capsule, intrahepatic spread, and tumor adjacent to large blood vessels were risk factors for ineffective recurrence of patients with primary liver cancer after radiofrequency ablation combined with hepatic artery intervention ( P < 0.05). Discussion. Tumor diameter ≥ 3 cm, incomplete capsule, intrahepatic spread, and tumor adjacent to large blood vessels are risk factors for the ineffectiveness of radiofrequency ablation combined with hepatic artery interventional therapy for patients with recurrence of primary liver cancer. It is necessary to increase the range of radiofrequency treatment, increase the temperature of the radiofrequency needle, and strengthen postoperative follow-up interventions based on the specific conditions of the patient's tumor.

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“…However, with increasing recognition of MVI and its prognostic value on surgical outcomes of HCC, preoperative MVI prediction systems for surgical decision making have become a hot topic in recent researches. In recent years, some studies have reported the possibility of imaging findings to predict the MVI of HCC (24)(25)(26)(27). However, it still has a limited capacity to detect MVI and the precise detection of MVI needs further histological identification (28).…”

Section: Introductionmentioning

confidence: 99%

Revisiting Surgical Strategies for Hepatocellular Carcinoma With Microvascular Invasion

Zhang

¹

,

Cheng

²

,

Huang

³

et al. 2021

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Although liver resection (LR) and liver transplantation (LT) are widely considered as potentially curative therapies for selected patients with hepatocellular carcinoma (HCC); however, there is still high risk of tumor recurrence in majority of HCC patients. Previous studies demonstrated that the presence of microvascular invasion (MVI), which was defined as the presence of tumor emboli within the vessels adjacent to HCC, was one of the key factors of early HCC recurrence and poor surgical outcomes after LR or LT. In this review, we evaluated the impact of current MVI status on surgical outcomes after curative therapies and aimed to explore the surgical strategies for HCC based on different MVI status with evidence from pathological examination. Surgical outcomes of HCC patients with MVI have been described as a varied range after curative therapies due to a broad spectrum of current definitions for MVI. Therefore, an international consensus on the validated definition of MVI in HCC is urgently needed to provide a more consistent evaluation and reliable prediction of surgical outcomes for HCC patients after curative treatments. We concluded that MVI should be further sub-classified into MI (microvessel invasion) and MPVI (microscopic portal vein invasion); for HCC patients with MPVI, local R0 resection with a narrow or wide surgical margin will get the same surgical results. However, for HCC patients with MI, local surgical resection with a wide and negative surgical margin will get better surgical outcomes. Nowadays, MVI status can only be reliably confirmed by histopathologic evaluation of surgical specimens, limiting its clinical application. Taken together, preoperative assessment of MVI is of utmost significance for selecting a reasonable surgical modality and greatly improving the surgical outcomes of HCC patients, especially in those with liver cirrhosis.

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“…Notably, the Child–Pugh B class is significantly different between the capsule group and noncapsule group in baseline characteristics of patients. This may be partly explained by the absence of capsule associated with more aggressive properties in HCC in that the presence of capsule might inhibit tumor cells' invasion, therefore exacerbating liver function [ 38 ]. Although there are a few limitations, the Child–Pugh class remains the most widely used grade to assess liver function and an independent prognostic factor for HCC patients.…”

Section: Discussionmentioning

confidence: 99%

Gene Polymorphism of MUC15, MMP14, BRAF, and COL1A1 Is Associated with Capsule Formation in Hepatocellular Carcinoma

Sun

¹

,

Zhang

²

,

Liu

³

et al. 2021

Canadian Journal of Gastroenterology and Hepatology

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Background. The presence of a capsule is an important prognostic factor in hepatocellular carcinoma (HCC). Capsule formation is affected by tumor-host interaction, which may include collagen deposition and extracellular matrix (ECM) degradation. Purpose. This study aimed to examine whether single-nucleotide polymorphisms (SNPs) in the genes for COL1A1 MUC15, MMP14, CD97, SMYD3, BRAF, and transforming growth factor beta 1 (TGF-β) are related to capsule formation. Methods. We prospectively recruited and analyzed 185 patients with HCC with or without a capsule between 2019 and 2020. The SNPs involved were analyzed by polymerase chain reaction. Differences in the allele and genotype frequency between the cases and controls were evaluated using the chi-square test. Odds ratios and 95% confidence intervals were calculated by logistic regression analysis with adjustment for age and sex. Stratification analyses were also performed with preselected variables. Results. The single-locus analysis showed that the presence of a capsule was significantly associated with five SNPs : MUC15 rs17309195 P = 0.01 , rs12271124 P = 0.02 , rs10430847 P = 0.04 , MMP14 rs17884816 P = 0.01 , and BRAF rs74512895 P = 0.03 . Adjusted logistic regression revealed that the decreased capsule formation was statistically significantly associated with BRAF rs76603725, COL1A1 rs2269336, and MUC15 rs17309195, while MMP14 rs17884816 and MUC15 rs10430847, rs2063278, and rs967490 were associated with increased capsule formation. The MUC15 block 2 haplotype was associated with increased capsule formation. Conclusions. MUC15, MMP14, BRAF, and COL1A1 gene polymorphisms are associated with capsule formation in HCC. Studies involving larger samples are needed to confirm our results.

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The importance of a nonsmooth tumor margin and incomplete tumor capsule in predicting HCC microvascular invasion on preoperative imaging examination: a systematic review and meta-analysis

Cited by 35 publications

References 24 publications

Effect of Radiofrequency Ablation with Interventional Therapy of Hepatic Artery on the Recurrence of Primary Liver Cancer and the Analysis of Influencing Factors

Effect of Radiofrequency Ablation with Interventional Therapy of Hepatic Artery on the Recurrence of Primary Liver Cancer and the Analysis of Influencing Factors

Revisiting Surgical Strategies for Hepatocellular Carcinoma With Microvascular Invasion

Gene Polymorphism of MUC15, MMP14, BRAF, and COL1A1 Is Associated with Capsule Formation in Hepatocellular Carcinoma

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