The predictive value of vessels encapsulating tumor clusters in treatment optimization for recurrent early‐stage hepatocellular carcinoma

Abstract

Background The predictive value of vessels encapsulating tumor clusters (VETC) in recurrent early‐stage hepatocellular carcinoma (HCC) remains unclear. Therefore, the aim of the present study was to investigate the prognostic significance of VETC in patients with recurrent early‐stage HCC after repeat hepatic resection (RHR) or radiofrequency ablation (RFA). Methods From December 2005 to December 2016, 138 patients receiving RHR and 188 patients receiving RFA were recruited. VETC was evaluated by immunohistochemical staining for CD34. The survival outcomes of patients with VETC pattern or not were investigated. Results There was no significant difference between the RHR and RFA groups in disease‐free survival (DFS) or overall survival (OS) as determined by the univariate analysis of the whole cohort. In the subgroup analysis of the VETC‐positive cohort, the patients in the RHR group showed a longer median DFS time in contrast to those in the RFA group (15.0 vs. 5.0 months, p = 0.001). Similarly, the patients in the RHR group showed a longer median OS time in contrast to those in the RFA group (39.5 vs. 19 months, p = 0.001). In the VETC‐negative cohort, no significant differences in DFS and OS rates between the RHR and RFA groups were observed (p > 0.05). Conclusions The results of our study suggested that RHR was relatively safe and superior to RFA in improving survival outcomes for recurrent early‐stage HCC after initial hepatectomy. Furthermore, the VETC pattern may represent a reliable marker for selecting HCC patients who may benefit from RHR.

Development and Validation of a Novel Nomogram for Predicting Vessels that Encapsulate Tumor Cluster in Hepatocellular Carcinoma

“…7 In addition, VETC pattern may represent a reliable marker for selecting recurrent early-stage HCC patients who may benefit from repeat hepatic resection. 8 Notably, it is suggested that the VETC pattern is associated with the effect of sorafenib treatment for HCC patients. Vessels that encapsulate tumor cluster-positive HCC patients may have a better prognosis than that of VETC-negative HCC patients when treated with sorafenib.…”

Meta-Analysis of Repeat Hepatectomy versus Radiofrequency Ablation for Recurrence of Hepatocellular Carcinoma

“…Seventeen total studies, incorporating 2597 total patients (1203 in the RHR group versus 1394 in the RFA group), were deemed eligible for inclusion in the final data analysis ( Figure 1 ) [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ]. The majority of studies originated from East Asia (nine studies from China, three from Japan, one from Singapore, two from Taiwan and one from Korea), while one study was an international multicenter study.…”

“…Regarding patient inclusion criteria, absence of extrahepatic spread, presence of intrahepatic HCC recurrence at a site distant from the original tumor and Child-Turcotte-Pugh (CTP) scores A or B were uniformly reported among the included studies. With respect to employed tumor number and size cut-offs, two studies [ 25 , 32 ] reported inclusion of patients with up to three tumors with a 3 cm size cut-off, while another two studies used 5 cm [ 38 ] and 6 cm cut-offs [ 36 ]. One study reported inclusion of BCLC stage 0 or A patients [ 31 ] and four studies adhered to the Milan criteria for size and number of tumors [ 23 , 24 , 30 , 33 ].…”

“… Forest plot for Overall Survival of patients undergoing repeat hepatic resection (RHR) versus radiofrequency ablation (RFA) of recurrent hepatocellular carcinoma [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ]. …”

“… Forest plot of overall mortality between the RHR and RFA groups [ 22 , 23 , 25 , 27 , 29 , 30 , 31 , 32 , 34 , 36 , 37 , 38 ]. …”