Abstract
Pathological MVI diagnosis could help to determine the prognosis and need for adjuvant therapy in hepatocellular carcinoma (HCC). However, narrative reporting (NR) would miss relevant clinical information and non-standardized sampling would underestimate MVI detection. Our objective was to explore the impact of innovative synoptic reporting (SR) and seven-point sampling (SPRING) protocol on microvascular invasion (MVI) rate and patient outcomes. In retrospective cohort, we extracted MVI status from NR in three centers and re-reviewed specimen sections by SR recommended by the College of American Pathologists (CAP) in our center. In prospective cohort, our center implemented the SPRING protocol, and external centers remained traditional pathological examination. MVI rate was compared between our center and external centers in both cohorts. Recurrence-free survival (RFS) before and after implementation was calculated by Kaplan-Meier method and compared by the log-rank test. In retrospective study, we found there was no significant difference in MVI rate between our center and external centers [10.3% (115/1112) vs. 12.4% (35/282), P=0.316]. In our center, SR recommended by CAP improved the MVI detection rate from 10.3 to 38.6% (P<0.001). In prospective study, the MVI rate in our center under SPRING was significantly higher than external centers (53.2 vs. 17%, P<0.001). RFS of MVI (−) patients improved after SPRING in our center (P=0.010), but it remained unchanged in MVI (+) patients (P=0.200). We conclude that the SR recommended by CAP could help to improve MVI detection rate. Our SPRING protocol could help to further improve the MVI rate and optimize prognostic stratification for HCC patients.
Highlights
The incidence of hepatocellular carcinoma (HCC) is rising globally
We demonstrated that SPRING protocol could help improve microvascular invasion (MVI) detection rate and make more accurate risk stratification on patient outcomes, when compared to traditional pathology examination in HCC patients
Studies on pathology reports confirmed that adverse prognostic factors like lymph node and resection margin involvement in pancreatic cancer, as well as extramural vascular invasion (EMVI) and lymph-vascular invasion (LVI) in colorectal cancer (CRC) were under-reported in traditional
Summary
The incidence of hepatocellular carcinoma (HCC) is rising globally. China contributes almost half of new-diagnosed HCC cases in the world, and HCC ranks the second in malignancy mortality in this country [1]. Microvascular invasion (MVI) refers to the microscopic finding of cancer cell nest within vessels lined by endothelium [2]. It frequently occurs in HCC and is significantly associated with early recurrence and poor survival outcomes of HCC patients [3]. Many studies have indicated adjuvant transarterial chemotherapy after hepatic resection could help to improve long-term survival in MVIpositive patients [4,5,6,7,8]. Previous studies showed the MVI positive rate after hepatectomy in pathology report varied substantially, from 7.8 to 57.1% [9]. An accurate and standardized report of MVI is needed for precise patient stratification and consequent individualized treatments
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