The Vessels That Encapsulate Tumor Clusters (VETC) Pattern Is a Poor Prognosis Factor in Patients with Hepatocellular Carcinoma: An Analysis of Microvessel Density

Abstract

The outcomes of patients with hepatocellular carcinoma (HCC) are unsatisfactory because of its high recurrence rate. The Vessels that encapsulate tumor clusters (VETC) pattern is a unique vascular structure. In this study, we investigated the clinical–pathological features of HCC patients with the VETC pattern. We retrospectively reviewed patients with HCC who underwent curative hepatectomy at Chang Gung Memorial Hospital between 2007 and 2013. The form of the VETC pattern was established using an anti-CD31 stain. The results were classified into positive (VETC+) and negative (VETC−) patterns. We investigated and compared demographic data between these two groups. Overall, 174 patients were classified into either the VETC+ or VETC− groups. The median followed-up period was 80.5 months. There were significant differences in the number of hepatitis B carriers, the occurrence of vascular invasion, tumor size, TNM staging, microvessel density, and recurrence (all p < 0.05). Regarding the prediction of disease-free survival, after COX regression multivariate analysis, VETC+ remained independently associated with recurrent episodes (p = 0.003). The intra-tumoral microvessel density, demonstrated by CD-31, was the only clinical–pathological feature independently associated with VETC+. Our study demonstrated that the VETC pattern is an independent factor of poor prognosis for DFS. Higher intra-tumoral microvessel density was significantly associated with the VETC pattern. Further studies are needed to validate our findings.

A multi-parametric prognostic model based on clinicopathologic features: vessels encapsulating tumor clusters and hepatic plates predict overall survival in hepatocellular carcinoma patients

“…The expression pattern of CD34 (Catalog number MAB-1076, Fuzhou Maixin Biotechnology Development Company, China) in HCC was evaluated by two independent pathologists (Mei-Fang Zhang and Chun-Hua Wang). CD34-labeled vessels that encapsulated tumor clusters were identified by the presence of cobweb-like networks with unequivocal immunoreactivity of a continuous lining [ 17 , 32 ]. Staining of CD34 spanning > 50% of the tumor surface was defined as VETC-positive (Fig.…”

Vessels that encapsulate tumour clusters vascular pattern in hepatocellular carcinoma

“… 24 Among resection with curative-intent cohorts (using presence of any VETC as the cut-off), the reported prevalence of VETC-positive HCCs ranges from 14.2-56.3% (mostly 30-40%). 11 , 19 , 24 , 25 , 27 , 29 , [33] , [34] , [35] , [36] In patients presenting with recurrent disease after their initial R0 (microscopically margin-negative) resection, the prevalence of VETC positivity was slightly higher: 55.5% for those with early recurrence undergoing repeat resection or radiofrequency ablation (RFA) and 48.9% in those with recurrence requiring sorafenib treatment. 10 , 28 Two studies have reported on VETC in patients with unresectable HCC undergoing LT. Our group observed a VETC-positive prevalence of 76.5% on liver explants of patients undergoing deceased-donor LT (DDLT) for HCC (<4% outside Milan LT criteria at the time of listing).…”

“…Compared to VETC-negative tumours, VETC-positive tumours are consistently larger in size (in particular, more tumours >5 cm) and appear in higher numbers ( Table 2 ). 10 , 19 , 27 , 30 , 34 , 37 , 38 Correspondingly, VETC-positive tumours are associated with a more advanced stage and significantly higher levels of serum tumour markers (α-fetoprotein [AFP], des-γ-carboxy prothrombin, protein induced by vitamin K absence II). 11 , 19 , 24 , 30 , 40 , 48 Among LT recipients, those with VETC-positive tumours spent longer on the waitlist and were more likely to be outside standard transplant listing criteria based on explant histology.…”

In Situ Nanofiber Patch Boosts Postoperative Hepatocellular Carcinoma Immune Activation by Trimodal Combination Therapy

“…12,13 Unlike traditional chemotherapy, its mechanism of action is more precise with fewer toxic side effects, making it a common modality applied in clinical practice. Given that HCC is typically a multivessel tumor, 14,15 growth factor receptor 2 (VEGFR2) and significant apoptotic and antiproliferative activities against HCC. 16 Su et al reported that AL can effectively inhibit angiogenesis in tumor tissues, normalize residual blood vessels, and increase effector T cells, macrophages, and antigen-presenting cells (APC) infiltration, thus improving the TME.…”

“…MTT is a type of treatment that uses drugs or other substances that target specific molecules to block the growth and spread of cancer cells. , Unlike traditional chemotherapy, its mechanism of action is more precise with fewer toxic side effects, making it a common modality applied in clinical practice. Given that HCC is typically a multivessel tumor, , various vascular targeting inhibitors, including anlotinib (AL), sorafenib, sunitinib, and pazopanib, are applied to reduce the tumor burden by destroying established tumor vessels. AL, as a multitargeting tyrosine kinase inhibitor, has a strong specific inhibitory effect against vascular endothelial growth factor receptor 2 (VEGFR2) and significant apoptotic and antiproliferative activities against HCC .…”