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Prognostic Value and Prediction of Extratumoral Microvascular Invasion for Hepatocellular Carcinoma

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

There are few reports on microvascular invasion (MVI) located intra- or extratumorally and prognosis of hepatocellular carcinoma (HCC).

Objective

The aim of this study was to evaluate patient outcome according to the location of MVI, and to build a nomogram predicting extratumoral MVI.

Methods

We included 681 consecutive patients who underwent hepatic resection (HR) or liver transplantation (LT) for HCC from January 1994 to June 2012, and evaluated patient outcome according to the degree of vascular invasion (VI). A nomogram for predicting extratumoral MVI was created using 637 patients, excluding 44 patients with macrovascular invasion, and was validated using an internal (n = 273) and external patient cohort (n = 256).

Results

The 681 patients were classified into four groups based on pathological examination (148 no VI, 33 intratumoral MVI, 84 extratumoral MVI, and 29 macrovascular invasion in patients who underwent HR; 238 no VI, 50 intratumoral MVI, 84 extratumoral MVI, and 15 macrovascular invasion in patients who underwent LT). Multivariate analysis revealed that extratumoral MVI was an independent risk factor for overall survival in patients who underwent HR (hazard ratio 2.62, p < 0.0001) or LT (hazard ratio 1.99, p = 0.0005). Multivariate logistic regression analysis identified six independent risk factors for extratumoral MVI: α-fetoprotein, tumor size, non-boundary type, alkaline phosphatase, neutrophil-to-lymphocyte ratio, and aspartate aminotransferase. The nomogram for predicting extratumoral MVI using these factors showed good concordance indices of 0.774 and 0.744 in the internal and external validation cohorts, respectively.

Conclusions

The prognostic value of MVI differs according to its invasiveness. The nomogram allows reliable prediction of extratumoral MVI in patients undergoing HR or LT.

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Authors and Affiliations

  1. Centre Hépato-Biliaire, AP-HP, Hôpital Paul Brousse, Univ Paris Sud, Inserm U 935 and U 1193, 9 avenue Paul Vaillant Couturier, 94804, Villejuif, France

    Hidetoshi Nitta MD, PhD, Marc-Antoine Allard MD, Oriana Ciacio MD, Gabriella Pittau MD, PhD, Eric Vibert MD, PhD, Antonio Sa Cunha MD, Daniel Cherqui MD, Denis Castaing MD, Henri Bismuth MD, PhD, Didier Samuel MD, PhD & René Adam MD, PhD

  2. Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan

    Hidetoshi Nitta MD, PhD & Hideo Baba MD, PhD

  3. Department of Pathology, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Villejuif, France

    Mylène Sebagh MD

  4. Department of Pathology, Bicêtre University Hospital, University of Paris-Sud, Orsay, France

    Catherine Guettier MD, PhD

  5. Department of Radiology, AP-HP, Hôpital Paul Brousse, Villejuif, France

    Maité Lewin

Authors
  1. Hidetoshi Nitta MD, PhD
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  2. Marc-Antoine Allard MD
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  15. René Adam MD, PhD
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Corresponding author

Correspondence to René Adam MD, PhD.

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Disclosure

Hidetoshi Nitta, Marc-Antoine Allard, Mylène Sebagh, Oriana Ciacio, Gabriella Pittau, Eric Vibert, Antonio Sa Cunha, Daniel Cherqui, Denis Castaing, Henri Bismuth, Catherine Guettier, Maité Lewin, Didier Samuel, Hideo Baba, and René Adam declare they have nothing to disclose regarding funding or conflicts of interest with respect to this study.

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Nitta, H., Allard, MA., Sebagh, M. et al. Prognostic Value and Prediction of Extratumoral Microvascular Invasion for Hepatocellular Carcinoma. Ann Surg Oncol 26, 2568–2576 (2019). https://doi.org/10.1245/s10434-019-07365-0

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  • DOI: https://doi.org/10.1245/s10434-019-07365-0

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