Abstract
Objective: Microvascular invasion is considered to initiate intrahepatic metastasis and postoperative recurrence of hepatocellular carcinoma (HCC). We aimed to analyze the effect of MVI on the prognosis in HCC and identify related risk factors for microvascular invasion (MVI).Methods: The clinical data of 553 HCC patients who underwent liver surgery at Qingdao University from January 2014 to December 2018 and 89 patients at Beijing Tsinghua Changgung Hospital treated between October 2014 and October 2019 were collected retrospectively. We explored the impact of MVI on the prognosis of patients with HCC using Kaplan-Meier analysis. We conducted logistic regression analysis to identify variables significantly related to MVI.Results: Pathological examination confirmed the presence of MVI in 265 patients (41.3%). Six factors independently correlated with MVI were incorporated into the multivariate logistic regression analysis: Edmondson-Steiner grade [odds ratio (OR) = 3.244, 95%CI: 2.243–4.692; p < 0.001], liver capsule invasion (OR = 1.755; 95%CI: 1.215–2.535; p = 0.003), bile duct tumor thrombi (OR = 20.926; 95%CI: 2.552–171.553; p = 0.005), α-fetoprotein (> 400 vs. < 400 ng/ml; OR = 1.530; 95%CI: 1.017–2.303; p = 0.041), tumor size (OR = 1.095; 95%CI: 1.027–1.166; p = 0.005), and neutrophil-lymphocyte ratio (OR = 1.086; 95%CI: 1.016–1.162; p = 0.015). The area under the receiver operating characteristic curve (AUC) was 0.743 (95%CI: 0.704–0.781; p < 0.001), indicating that our logistic regression model had significant clinical usefulness.Conclusions: We analyzed the effect of MVI on the prognosis in HCC and evaluated the risk factors for MVI, which could be helpful in making decisions regarding patients with a high risk of recurrence.
Highlights
Primary liver cancer is the third leading cause of cancer-related deaths worldwide with more than 900,000 new cases annually [1]
We explored the effect of Microvascular invasion (MVI) on the prognosis and identified the risk factors associated with MVI to provide clues identifying the Hepatocellular carcinoma (HCC) with a high risk of recurrence
The major inclusion criteria were as follows: [1] liver cancer without distant metastasis on preoperative imaging examination, [2] hepatectomy with tumor confirmed as HCC by histology, [3] available pathological sections and pathological report data, and [4] survival and recurrence information obtained by follow-up
Summary
Primary liver cancer is the third leading cause of cancer-related deaths worldwide with more than 900,000 new cases annually [1]. Hepatocellular carcinoma (HCC) is the major pathologic category of primary liver cancer (PLC) and accounts for ∼90% of all pathological types. Treatments for HCC have become increasingly diversified with the development of targeted therapy and immunotherapy [2], the prognosis remains poor [3]. Hepatectomy and liver transplantation are the preferred therapies for HCC, according to the international guidelines. The study of Llovet et al reported that the 5-year recurrence and metastasis rates were 40–70% after surgery [4]. The 5-year recurrence rate after surgery is as high as 80% for tumors larger than 5 cm and 40–50% for tumors smaller than 5 cm [5]. Recurrence is a key factor affecting the overall survival (OS) in patients with HCC. Screening for early metastasis and predictors of recurrence is important
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