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Actual long-term survival in hepatocellular carcinoma patients with microvascular invasion: a multicenter study from China

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Abstract

Background

Microvascular invasion (MVI) is a risk factor for postoperative survival outcomes for hepatocellular carcinoma (HCC) after liver resection (LR). This study aims to investigate the actual long-term survival and its associated prognostic factors after LR for HCC patients with MVI.

Methods

This study was conducted on HCC patients with MVI who underwent LR from January 2009 to December 2012 at five major hospitals in China. The patients were divided into the ‘long-term survivor group’ and the ‘short-term survivor group’. The clinicopathologic characteristics, perioperative data and survival outcomes were compared between these two groups. Univariate and multivariate regression analyses were performed to identify predictive factors associated with long-term survival outcomes.

Results

The study included 1517 patients with an actual 5-year survival rate of 33.3%. Multivariate regression analysis revealed that HBV DNA > 104 IU/mL, alanine aminotransferase > 44 U/L, alpha-fetoprotein > 400 ng/ml, anatomical hepatectomy, varices, intraoperative blood loss > 400 ml, tumor diameter > 5 cm, tumor number, satellite nodules, tumor encapsulation, wide resection margin and adjuvant transarterial chemoembolization (TACE) were independent prognostic factors associated with actual long-term survival.

Conclusions

One-third of HCC patients with MVI reached the long-term survival milestone of 5 years after resection. Anatomical hepatectomy, controlling intraoperative blood loss, a wide resection margin, and postoperative adjuvant TACE should be considered for patients to achieve better long-term survival outcomes.

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Data availability

The data used and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol. 2018;69(1):182–236.

    Article  Google Scholar 

  2. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424.

    Article  Google Scholar 

  3. Omata M, Cheng AL, Kokudo N, et al. Asia-Pacific clinical practice guidelines on the management of hepatocellular carcinoma: a 2017 update. Hepatol Int. 2017;11(4):317–70.

    Article  Google Scholar 

  4. Forner A, Reig M, Bruix J. Hepatocellular carcinoma. Lancet. 2018;391(10127):1301–14.

    Article  Google Scholar 

  5. Marrero JA, Kulik LM, Sirlin CB, et al. Diagnosis, Staging, and Management of Hepatocellular Carcinoma: 2018 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology. 2018;68(2):723–50.

    Article  Google Scholar 

  6. Bruix J, Reig M, Sherman M. Evidence-Based Diagnosis, Staging, and Treatment of Patients With Hepatocellular Carcinoma. Gastroenterology. 2016;150(4):835–53.

    Article  Google Scholar 

  7. Cong WM, Bu H, Chen J, et al. Practice guidelines for the pathological diagnosis of primary liver cancer: 2015 update. World J Gastroenterol. 2016;22(42):9279–87.

    Article  Google Scholar 

  8. Rodriguez-Peralvarez M, Luong TV, Andreana L, Meyer T, Dhillon AP, Burroughs AK. A systematic review of microvascular invasion in hepatocellular carcinoma: diagnostic and prognostic variability. Ann Surg Oncol. 2013;20(1):325–39.

    Article  Google Scholar 

  9. Zhang X, Li J, Shen F, Lau WY. Significance of presence of microvascular invasion in specimens obtained after surgical treatment of hepatocellular carcinoma. J Gastroenterol Hepatol. 2018;33(2):347–54.

    Article  Google Scholar 

  10. Chen ZH, Zhang XP, Wang H, et al. Effect of microvascular invasion on the postoperative long-term prognosis of solitary small HCC: a systematic review and meta-analysis. HPB (Oxford). 2019;21(8):935–44.

    Article  Google Scholar 

  11. Wang H, Wu MC, Cong WM. Microvascular invasion predicts a poor prognosis of solitary hepatocellular carcinoma up to 2 cm based on propensity score matching analysis. Hepatol Res. 2019;49(3):344–54.

    Article  CAS  Google Scholar 

  12. Du M, Chen L, Zhao J, et al. Microvascular invasion (MVI) is a poorer prognostic predictor for small hepatocellular carcinoma. BMC Cancer. 2014;14:38.

    Article  Google Scholar 

  13. Lei Z, Li J, Wu D, et al. Nomogram for Preoperative Estimation of Microvascular Invasion Risk in Hepatitis B Virus-Related Hepatocellular Carcinoma Within the Milan Criteria. JAMA Surg. 2016;151(4):356–63.

    Article  Google Scholar 

  14. Ma X, Wei J, Gu D, et al. Preoperative radiomics nomogram for microvascular invasion prediction in hepatocellular carcinoma using contrast-enhanced CT. Eur Radiol. 2019;29(7):3595–605.

    Article  Google Scholar 

  15. Hu HT, Wang Z, Huang XW, et al. Ultrasound-based radiomics score: a potential biomarker for the prediction of microvascular invasion in hepatocellular carcinoma. Eur Radiol. 2019;29(6):2890–901.

    Article  Google Scholar 

  16. Chen ZH, Zhang XP, Zhou TF, et al. Adjuvant transarterial chemoembolization improves survival outcomes in hepatocellular carcinoma with microvascular invasion: A systematic review and meta-analysis. Eur J Surg Oncol. 2019;45(11):2188–96.

    Article  Google Scholar 

  17. Wei W, Jian PE, Li SH, et al. Adjuvant transcatheter arterial chemoembolization after curative resection for hepatocellular carcinoma patients with solitary tumor and microvascular invasion: a randomized clinical trial of efficacy and safety. Cancer Commun (Lond). 2018;38(1):61.

    Article  Google Scholar 

  18. Wang H, Du PC, Wu MC, Cong WM. Postoperative adjuvant transarterial chemoembolization for multinodular hepatocellular carcinoma within the Barcelona Clinic Liver Cancer early stage and microvascular invasion. Hepatobiliary Surg Nutr. 2018;7(6):418–28.

    Article  Google Scholar 

  19. Wang L, Wang W, Yao X, et al. Postoperative adjuvant radiotherapy is associated with improved survival in hepatocellular carcinoma with microvascular invasion. Oncotarget. 2017;8(45):79971–81.

    Article  Google Scholar 

  20. Zhang XP, Chai ZT, Gao YZ, et al. Postoperative adjuvant sorafenib improves survival outcomes in hepatocellular carcinoma patients with microvascular invasion after R0 liver resection: a propensity score matching analysis. HPB (Oxford). 2019;21(12):1687–96.

    Article  Google Scholar 

  21. Sun JJ, Wang K, Zhang CZ, et al. Postoperative Adjuvant Transcatheter Arterial Chemoembolization After R0 Hepatectomy Improves Outcomes of Patients Who have Hepatocellular Carcinoma with Microvascular Invasion. Ann Surg Oncol. 2016;23(4):1344–51.

    Article  Google Scholar 

  22. Strasberg SM, Phillips C. Use and dissemination of the brisbane 2000 nomenclature of liver anatomy and resections. Ann Surg. 2013;257(3):377–82.

    Article  Google Scholar 

  23. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–96.

    Article  Google Scholar 

  24. Wei X, Li N, Li S, et al. Hepatitis B virus infection and active replication promote the formation of vascular invasion in hepatocellular carcinoma. BMC Cancer. 2017;17(1):304.

    Article  Google Scholar 

  25. Li Z, Lei Z, Xia Y, et al. Association of Preoperative Antiviral Treatment With Incidences of Microvascular Invasion and Early Tumor Recurrence in Hepatitis B Virus-Related Hepatocellular Carcinoma. JAMA Surg. 2018;153(10):e182721.

    Article  Google Scholar 

  26. Zhang XP, Wang K, Wei XB, et al. An Eastern Hepatobiliary Surgery Hospital Microvascular Invasion Scoring System in Predicting Prognosis of Patients with Hepatocellular Carcinoma and Microvascular Invasion After R0 Liver Resection: A Large-Scale, Multicenter Study. Oncologist. 2019;24(12):e1476–88.

    CAS  PubMed  PubMed Central  Google Scholar 

  27. Cucchetti A, Qiao GL, Cescon M, et al. Anatomic versus nonanatomic resection in cirrhotic patients with early hepatocellular carcinoma. Surgery. 2014;155(3):512–21.

    Article  Google Scholar 

  28. Shi C, Zhao Q, Liao B, et al. Anatomic resection and wide resection margin play an important role in hepatectomy for hepatocellular carcinoma with peritumoural micrometastasis. ANZ J Surg. 2019;89(11):E482–6.

    Article  Google Scholar 

  29. Zhong XP, Zhang YF, Mei J, et al. Anatomical versus non-anatomical resection for hepatocellular carcinoma with microscope vascular invasion: a propensity score matching analysis. J Cancer. 2019;10(17):3950–7.

    Article  Google Scholar 

  30. Katz SC, Shia J, Liau KH, et al. Operative blood loss independently predicts recurrence and survival after resection of hepatocellular carcinoma. Ann Surg. 2009;249(4):617–23.

    Article  Google Scholar 

  31. Han J, Li ZL, Xing H, et al. The impact of resection margin and microvascular invasion on long-term prognosis after curative resection of hepatocellular carcinoma: a multi-institutional study. HPB (Oxford). 2019;21(8):962–71.

    Article  Google Scholar 

  32. Ye JZ, Chen JZ, Li ZH, et al. Efficacy of postoperative adjuvant transcatheter arterial chemoembolization in hepatocellular carcinoma patients with microvascular invasion. World J Gastroenterol. 2017;23(41):7415–24.

    Article  Google Scholar 

  33. Wang YY, Wang LJ, Xu D, et al. Postoperative adjuvant transcatheter arterial chemoembolization should be considered selectively in patients who have hepatocellular carcinoma with microvascular invasion. HPB (Oxford). 2019;21(4):425–33.

    Article  Google Scholar 

  34. Qi YP, Zhong JH, Liang ZY, et al. Adjuvant transarterial chemoembolization for patients with hepatocellular carcinoma involving microvascular invasion. Am J Surg. 2019;217(4):739–44.

    Article  Google Scholar 

  35. Cucchetti A, Piscaglia F, Caturelli E, et al. Comparison of recurrence of hepatocellular carcinoma after resection in patients with cirrhosis to its occurrence in a surveilled cirrhotic population. Ann Surg Oncol. 2009;16(2):413–22.

    Article  Google Scholar 

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Funding

The Key Project of the Natural Science Foundation of China (No: 81730097); the Grants of the Science Fund for Creative Research Groups (No: 81521091); the National Natural Science Foundation of China (No: 81602523); the Youth Project of Shanghai Municipal Health Commission (No: 20184Y0153).

Author information

Author notes

  1. Zhen-Hua Chen, Xiu-Ping Zhang, and Jin-Kai Feng have contributed equally to this work.

Authors and Affiliations

  1. Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225 Changhai Road, Shanghai, 200433, China

    Zhen-Hua Chen, Xiu-Ping Zhang, Jin-Kai Feng, Jie Shi, Wei-Xing Guo, Meng-Chao Wu, Wan Yee Lau & Shu-Qun Cheng

  2. Department of General Surgery, Zhejiang Provincial Armed Police Corps Hospital, Hangzhou, Zhejiang, China

    Zhen-Hua Chen

  3. Faculty of Hepato-Biliary-Pancreatic Surgery, The First Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China

    Xiu-Ping Zhang

  4. Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China

    Le-Qun Li

  5. Department of Hepatobiliary Surgery, Affiliated Hospital of Binzhou Medical College, Binzhou, Shandong, China

    Fan Zhang

  6. Department of General Surgery, Wenzhou People’s Hospital, Wenzhou, Zhejiang, China

    Yi-Ren Hu

  7. Department of Hepatobiliary Surgery, LongYan First Hospital Affiliated to Fujian Medical University, Longyan, Fujian, China

    Cheng-Qian Zhong

  8. Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China

    Wan Yee Lau

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  1. Zhen-Hua Chen
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Contributions

Conception and design: S-QC, Z-HC, X-PZ, J-KF, WYL, M-CW. Financial support: S-QC. Provision of study materials or patients: L-QL, FZ, Y-RH, C-QZ, JS, W-XG. Collection and assembly of data: Z-HC, X-PZ, J-KF. Data analysis and interpretation: Z-HC, X-PZ, J-KF. Manuscript writing: Z-HC, WYL. Final approval of the manuscript: all authors.

Corresponding author

Correspondence to Shu-Qun Cheng.

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Conflict of interest

The authors who participate in this study have no conflicts of interest to declare.

Ethical approval

This study was approved by the Institutional Ethics Committees of all the five participating hospitals.

Animal research

Not applicable.

Consent to participate

Written informed consent was obtained from all the patients for their consent to participate in this study and for their data to be used for research purposes.

Consent to publishing

Written informed consent was obtained from all the patients for their data to be used for research purposes.

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Not applicable.

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Chen, ZH., Zhang, XP., Feng, JK. et al. Actual long-term survival in hepatocellular carcinoma patients with microvascular invasion: a multicenter study from China. Hepatol Int 15, 642–650 (2021). https://doi.org/10.1007/s12072-021-10174-x

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  • DOI: https://doi.org/10.1007/s12072-021-10174-x

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