Abstract
Microvascular invasion (MVI) is well known to negatively influence outcomes following surgical treatment of hepatocellular cancer (HCC) patients. The aim of this study was to evaluate the rationale for prediction of MVI before liver transplantation (LT). Data of 200 HCC patients after LT were subject to retrospective analysis. MVI was present in 57 patients (28.5%). Tumor number (p = 0.001) and size (p = 0.009), and alpha-fetoprotein (p = 0.049) were independent predictors of MVI used to create a prediction model, defined as: 0.293x(tumor number) + 0.283x(tumor size in cm) + 0.164xloge(alpha-fetoprotein in ng/ml) (c statistic = 0.743). The established cut-off (≥2.24) was associated with sensitivity and specificity of 72%. MVI was not an independent risk factor for recurrence (p = 0.307), in contrast to tumor number (p = 0.047) and size (p < 0.001), alpha-fetoprotein (p < 0.001) and poor differentiation (p = 0.039). Recurrence-free survival at 5 years for patients without MVI was 85.9% as compared to 83.3% (p = 0.546) and 55.3% (p = 0.001) for patients with false negative and true positive prediction of MVI, respectively. The use of both morphological and biological tumor features enables effective pre-transplant prediction of high-risk MVI. Provided that these parameters are combined in selection of HCC patients for LT, pre-transplant identification of all patients with MVI does not appear necessary.
Highlights
Assessment of microvascular invasion on the basis of histopathological examination of the explanted liver precluded its incorporation into the selection process to date
Microvascular invasion is frequently reported as a major risk factor for hepatocellular cancer (HCC) recurrence following liver transplantation[20,38,39]
In order to facilitate its inclusion into the selection process, a wide variety of studies are focused on optimizing methods of preoperative prediction of microvascular invasion using imaging modalities and other pre-transplant factors[27,28,29,30,40,41,42]
Summary
Assessment of microvascular invasion on the basis of histopathological examination of the explanted liver precluded its incorporation into the selection process to date. For this reason, a large number of studies focused on the methods of pre-transplant prediction of this negative tumor feature. Significant predictors of microvascular invasion are risk factors for post-transplant tumor recurrence[8,11,13,16,20]. False negative results of prediction of microvascular invasion basing on other well-known factors for tumor recurrence are limited to patients at generally low risk of recurrence. The aim of the present study was to evaluate the rationale for prediction of microvascular invasion prior to liver transplantation
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