The presence of microvascular invasion guides treatment strategy in recurrent HBV-related HCC.

Abstract

We used the status of microvascular invasion (MVI) at primary resection to help treatment selection for hepatitis B virus-positive (HBV+) recurrent hepatocellular carcinoma (rHCC) patients in Barcelona Clinic Liver Cancer (BCLC) stage B-C. From 2009 to 2017, we enrolled 221 consecutive HBV+ rHCC patients at BCLC stage B-C who underwent re-resection (RR), radiofrequency ablation (RFA), or transarterial chemoembolization (TACE). Post recurrence survival (PRS) and overall survival (OS) were compared between RR/RFA and TACE according to MVI status. A one-to-one propensity score matching analysis was performed. For MVI(-) patients, the median PRS was 62.3months for the RR/RFA group and 21.1months for the TACE group (p = 0.039). The corresponding OS was 71.4months and 26.6months, respectively (p = 0.010). For MVI(+) patients, the median PRS in the RR/RFA group and TACE group was 14.7months and 10.1months (p = 0.115). The corresponding OS was 23.4months and 16.4months, respectively (p = 0.067). After matching, the dominance of RR/RFA over TACE remained in MVI(-) patients for both PRS (62.3months vs 15.3months, p = 0.019) and OS (98.1months vs 33.4months, p = 0.046). No significant difference was found in MVI(+) patients for either PRS (14.7months vs 11.8months, p = 0.593) or OS (23.4months vs 28.1months, p = 0.662). MVI status definitely helps select treatment options in HBV+ rHCC patients. For MVI(-) patients, RR/RFA provided better survival than TACE while for MVI(+) patients, TACE shared similar survival outcomes. • This study aimed at the determination of the optimal treatment options (ablation /resection vs TACE) in case of recurrent HBV-related HCC. • It showed that MVI status, established at primary resection of HCC, was a powerful marker for selecting the best treatment option in these patients. • In MVI(-) patients, RR/RFA achieved a better survival than TACE. In MVI(+) patients, TACE shared similar survival.