Abstract
BackgroundMicrovascular invasion (MVI) is a significant risk factor affecting survival outcomes of patients after R0 liver resection (LR) for hepatocellular carcinoma (HCC). However, whether the existing staging systems of hepatocellular carcinoma can distinguish the prognosis of patients with MVI and the prognostic value of MVI in different subtypes of hepatocellular carcinoma remains to be clarified.MethodsA dual-center retrospective data set of 1,198 HCC patients who underwent R0 LR was included in the study between 2014 and 2016. Baseline characteristics and staging information were collected. Homogeneity and modified Akaike information criterion (AICc) were compared between each system. And the prognostic significance of MVI for overall survival (OS) was studied in each subgroup.ResultsIn the entire cohort, there were no significant survival differences between Cancer of the Liver Italian Program (CLIP) score 2 and 3 (p = 0.441), and between Taipei Integrated Scoring System (TIS) score 3 and 4 (p = 0.135). In the MVI cohort, there were no significant survival differences between Barcelona Clinic Liver Cancer stages B and C (p=0.161), CLIP scores 2 and 3 (p = 0.083), TIS scores 0 and 1 (p = 0.227), TIS scores 2 and 3 (p =0.794), Tokyo scores 3 and 4 (p=0.353), and American Joint Committee on Cancer Tumor-Node-Metastasis 7th stage I and II (p=0.151). Among the eight commonly used HCC staging systems, the Hong Kong Liver Cancer (HKLC) staging system showed the highest homogeneity and the lowest AICc value in both the entire cohort and MVI cohort. In each subgroup of the staging systems, MVI generally exhibited poor survival outcomes.ConclusionsThe HKLC staging system was the most accurate model for discriminating the prognosis of MVI patients, among the eight staging systems. Meanwhile, our findings suggest that MVI may be needed to be incorporated into the current HCC staging systems as one of the grading criteria.
Highlights
Hepatocellular carcinoma (HCC) is the leading cause of cancerrelated death and responsible for more than 700,000 deaths annually [1]
There were some differences at baseline between patients with Microvascular invasion (MVI) and those without MVI (Supplemental Table 1)
Whether the current HCC staging systems are able to distinguish the prognosis of MVI patients and whether the prognostic significance of MVI in different subgroups of HCC staging systems are worth exploring
Summary
Hepatocellular carcinoma (HCC) is the leading cause of cancerrelated death and responsible for more than 700,000 deaths annually [1]. The 5-year recurrence rate is as high as 70–80% after curative liver resection, which severely limits the long-term survival of patients with HCC [5, 6]. Microvascular invasion (MVI), defined as “a cancer cell nest with >50 cells in the endothelial vascular lumen under microscopy” [7], is considered an early means of cancer cell spread through the vasculature and a key factor affecting the recurrence and long-term survival of patients with HCC [8–12]. The long-term survival of small HCC (≤2 cm) is excellent and not influenced by MVI [13], and the clinical value of MVI in patients at Barcelona Clinic Liver Cancer (BCLC) stages 0 or B is limited [12, 14]. Microvascular invasion (MVI) is a significant risk factor affecting survival outcomes of patients after R0 liver resection (LR) for hepatocellular carcinoma (HCC). Whether the existing staging systems of hepatocellular carcinoma can distinguish the prognosis of patients with MVI and the prognostic value of MVI in different subtypes of hepatocellular carcinoma remains to be clarified
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