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Journal of Gastrointestinal Surgery
Published in: Journal of Gastrointestinal Surgery 4/2019

01-04-2019 | Magnetic Resonance Imaging | Original Article

A Clinical Scoring System for Predicting Microvascular Invasion in Patients with Hepatocellular Carcinoma Within the Milan Criteria

Authors: Tomoki Ryu, Yuko Takami, Yoshiyuki Wada, Masaki Tateishi, Takanobu Hara, Munehiro Yoshitomi, Seiya Momosaki, Kotaro Yasumori, Hideki Saitsu, Koji Okuda

Published in: Journal of Gastrointestinal Surgery | Issue 4/2019

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Abstract

Background

Microvascular invasion (MVI) is recognized as a risk factor for early recurrence of hepatocellular carcinoma (HCC) within the Milan criteria after curative treatment.

Methods

One hundred eleven consecutive patients with HCC within the Milan criteria who underwent hepatic resection were retrospectively reviewed. Independent preoperative predictors of MVI were identified, and a scoring system was developed using significant predictors.

Results

MVI was identified in 51 of 111 patients (46%). Multivariate analysis identified the following independent predictors of MVI: alpha-fetoprotein (AFP) of > 95 ng/mL (odds ratio [OR], 9.87; 95% confidence interval [95% CI], 2.24–56.8; P = 0.002), des-γ-carboxy prothrombin (DCP) of > 55 mAU/mL (OR, 5.50; 95% CI, 2.09–15.4; P < 0.001), tumor size of > 2.8 cm (OR, 6.10; 95% CI, 2.07–20.0; P < 0.001), and non-smooth tumor margin in the hepatobiliary phase of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) (OR, 5.34; 95% CI, 1.84–16.9; P = 0.002). A clinical scoring system was developed using these four variables. Within a total possible score of 0 to 4, the prevalence of MVI with a score of 0, 1, 2, 3, and 4 was 4.5%, 24.0%, 45.5%, 91.7%, and 100%, respectively (P < 0.001). The area under the curve of the scoring system was 0.865 based on the receiver operating characteristic curve analysis of the prediction score.

Conclusions

Our clinical scoring system, consisting of AFP, DCP, tumor size, and tumor margin in Gd-EOB-DTPA-enhanced MRI, can be valuable for predicting MVI in HCC within the Milan criteria before curative treatment.
Literature
1.
Mazzaferro V, Regalia E, Doci R, Andrela S, Pulvirenti A, Bozzetti F, Montalto F, Ammatuna M, Morabito A, Gennari L. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 1996;344:693–700.CrossRef
2.
European Association for the Study of the Liver, European Organisation for Research and Treatment of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2012;56:908–943.CrossRef
3.
4.
Liver Cancer Study Group of Japan Primary liver cancer in Japan. Clinicopathologic features and results of surgical treatment. Ann Surg 1990;211:277–287.
5.
Izumi R, Shimizu K, Ii T, Yagi M, Matsui O, Nonomura A, Miyazaki I. Prognostic factors of hepatocellular carcinoma in patients undergoing hepatic resection. Gastroenterology 1994;106:720–727.CrossRefPubMed
6.
Poon RT, Fan ST, Lo CM, Liu CL, Wong J. Difference in tumor invasiveness in cirrhotic patients with hepatocellular carcinoma fulfilling the Milan criteria treated by resection and transplantation. Impact on long-term survival. Ann Surg 2007;245:51–58.CrossRefPubMedPubMedCentral
7.
Otto G, Heuschen U, Hofmann WJ, Krumm G, Hinz U, Herfarth C. Survival and recurrence after liver transplantation versus liver resection for hepatocellular carcinoma: a retrospective analysis. Ann Surg 1998;227:424–432.CrossRefPubMedPubMedCentral
8.
Shirabe K, Itoh S, Yoshizumi T, Soejima Y, Taketomi A, Aishima S, Maehara Y. The predictors of microvascular invasion in candidates for liver transplantation with hepatocellular carcinoma: with special reference to the serum levels of des-gamma-carboxy prothrombin. J Surg Oncol 2007;95:235–240.CrossRefPubMed
9.
Kaibori M, Ishizaki M, Matsui K, Kwon AH. Predictors of microvascular invasion before hepatectomy for hepatocellular carcinoma. J Surg Oncol 2010;102:462–468.CrossRefPubMed
10.
Sakata J, Shirai Y, Wakai T, Kaneko K, Nagahashi M, Hatakeyama K. Preoperative predictors of vascular invasion in hepatocellular carcinoma. Eur J Surg Oncol 2008;34:900–905.CrossRefPubMed
11.
Sumie S, Kuromatsu R, Okuda K, Ando E, Takata A, Fukushima N, Watanabe Y, Kojiro M, Sata M. Microvascular invasion in patients with hepatocellular carcinoma and its predictable clinicopathological factors. Ann Surg Oncol 2008;15:1375–1382.CrossRefPubMed
12.
Kim H, Park MS, Choi JY, Park YN, Kim MJ, Kim KS, Choi JS, Han KH, Kim EJ, Kim KW. Can microvessel invasion of hepatocellular carcinoma be predicted by pre-operative MRI? Eur Radiol 2009;19:1744–1751.CrossRefPubMed
13.
Nishie A, Yoshimitsu K, Asayama Y, Irie H, Tajima T, Hirakawa M, Ishigami K, Nakayama T, Kakihara D, Nishihara Y, Taketomi A, Honda H. Radiologic detectability of minute portal venous invasion in hepatocellular carinoma. Am J Roentgenol 2008;190:81–87.CrossRef
14.
Ariizumi S, Kitagawa K, Kotera Y, Takahashi Y, Katagiri S, Kuwatsuru R, Yamamoto M. A non-smooth tumor margin in the hepatobiliary phase of gadoxetic acid disodium (Gd-EOB-DTPA)-enhanced magnetic resonance imaging predicts microscopic portal vein invasion, intrahepatic metastasis, and early recurrence after hepatectomy in patients with hepatocellular carcinoma. J Hepatobiliary Pancreat Sci 2011;18:575–585.CrossRefPubMed
15.
Yu HC, Cheng JS, Lai KH, Lin CP, Lo GH, Lin CK, Hsu PI, Chan HH, Lo CC, Tsai WL, Chen WC. Factors for early tumor recurrence of single small hepatocellular carcinoma after percutaneous radiofrequency ablation therapy. World J Gastroenterol 2005;11:1439–1444.CrossRefPubMedPubMedCentral
16.
Imamura J, Tateishi R, Shiina S, Goto E, Sato T, Ohki T, Masuzaki R, Goto T, Yoshida H, Kanai F, Hamamura K, Obi S, Yoshida H, Omata M. Neoplastic seeding after radiofrequency ablation for hepatocellular carcinoma. Am J Gastroenterol 2008;103:3057–3062.CrossRefPubMed
17.
Ueno M, Hayami S, Shigekawa Y, Kawai M, Hirono S, Okada K, Tamai H, Shingaki N, Mori Y, Ichinose M, Yamaue H. Prognostic impact of surgery and radiofrequency ablation on single nodular HCC ≤5 cm: Cohort study based on serum HCC markers. J Hepatol 2015;65:1352–1359.CrossRef
18.
Hasegawa K, Kokudo N, Imamura H, Matsuyama Y, Aoki T, Minagawa M, Sano K, Sugawara Y, Takayama T, Makuuchi M. Prognostic impact of anatomic resection for hepatocellular carcinoma. Ann Surg 2005;242:252–259.CrossRefPubMedPubMedCentral
19.
Makuuchi M, Kosuge T, Takayama T, Yamazaki S, Kakazu T, Miyagawa S, Kawasaki S. Surgery for small liver cancers. Semin Surg Oncol 1993;9:298–304.CrossRefPubMed
20.
Belghiti J, Clavien PA, Gadzijev E, Garden JO, Lau WY, Makuuchi M, Strong RW et al. The Brisbane 2000 terminology of liver anatomy and resections. HBP 2000;2:333–339.
21.
Liver Cancer Study Group of Japan. General Rules for the Clinical and Pathological Study of Primary Liver Cancer, 3rd English edn. Tokyo: Kanehara Shuppan, 2010.
22.
Hirokawa F, Hayashi M, Miyamoto Y, Asakuma M, Shimizu T, Komeda K, Inoue Y, Uchiyama K. Outcomes and predictors of microvascular invasion of solitary hepatocellular carcinoma. Hepatol Res 2014;44: 846–853.CrossRefPubMed
23.
Ryu T, Takami Y, Wada Y, Tateishi M, Matsushima H, Mikagi K, Saitsu H. Double- and triple-positive tumor markers predict early recurrence and poor survival in patients with hepatocellular carcinoma within the Milan criteria and Child-Pugh Class A. J Gastrointest Surg 2017;21:957–966.CrossRefPubMed
24.
Koike Y, Shiratori Y, Sato S, Obi S, Teratani T, Imamura M, Yoshida H, Shiina S, Omata M. Des-γ-carboxy prothrombin as a useful predisposing factor for the development of portal venous invasion in patients with hepatocellular carcinoma: a prospective analysis of 227 patients. Cancer 2001;91:561–569.CrossRefPubMed
25.
Pote N, Cauchy F, Albuquerque M, Voitot H, Belghiti J, Castera L, Puy H, Bedossa P, Paradis V. Performance of PIVKA-II for early hepatocellular carcinoma diagnosis and prediction of microvascular invasion. J Hepatol 2015;62:848–854.CrossRefPubMed
26.
Di Bisceglie AM, Sterling RK, Chung RT, Everhart JE, Dienstag JL, Bonkovsky HL, Wright EC, Everson GT, Lindsay KL, Lok AS, Lee WM, Morgan TR, Ghany MG, Gretch DR, HALT-C Trial Group: Serum alpha-fetoprotein levels in patients with advanced hepatitis C: results from the HALT-C Trial. J Hepatol 2005;43:434–441.CrossRefPubMed
27.
Marrero JA, Feng Z, Wang Y, Nguyen MH, Befeler AS, Roberts LR, Reddy KR, Harnois D, Llovet JM, Normolle D, Dalhgren J, Chia D, Lok AS, Wagner PD, Srivastava S, Schwartz M. Alpha-fetoprotein, des-gamma carboxyprothrombin, and lectin-bound alpha-fetoprotein in early hepatocellular carcinoma. Gastroenterology. 2009;137:110–118.CrossRefPubMedPubMedCentral
28.
Nakashima Y, Nakashima O, Tanaka M, Okuda K, Nakashima M, Kojiro M. Portal vein invasion and intrahepatic micrometastasis in small hepatocellular carcinoma by gross type. Hepatol Res 2003;26:142–147.CrossRefPubMed
29.
Fujinaga Y, Kadoya M, Kozaka K, Shinmura R, Matsui O, Takayama T, Yamamoto M, Kokudo N, Kawasaki S, Arii S. Prediction of macroscopic findings of hepatocellular carcinoma on hepatobiliary phase of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging:correlation with pathology. Hepatol Res. 2013;43:488–494.CrossRefPubMed
30.
Ueno S, Kubo F, Sakoda M, Hiwatashi K, Tateno T, Mataki Y, Maemura K, Shinchi H, Natsugoe S, Aikou T. Efficacy of anatomic resection vs. nonanatomic resection for small nodular hepatocellular carcinoma based on gross classification. J Hepatobiliary Pancreat Sci 2008;15:493–500.CrossRef
31.
Agrawal S, Belghiti J. Oncologic resection for malignant tumors of the liver. Ann Surg 2011;253:656–665.CrossRefPubMed
32.
Fukutomi S, Nomura Y, Nakashima O, Yano H, Tanaka H, Akagi Y, Okuda K. Evaluation of hepatocellular carcinoma spread via the portal system by 3-dimensional mapping. HPB 2017;19:1119–1125.CrossRefPubMed
Metadata
Title
A Clinical Scoring System for Predicting Microvascular Invasion in Patients with Hepatocellular Carcinoma Within the Milan Criteria
Authors
Tomoki Ryu
Yuko Takami
Yoshiyuki Wada
Masaki Tateishi
Takanobu Hara
Munehiro Yoshitomi
Seiya Momosaki
Kotaro Yasumori
Hideki Saitsu
Koji Okuda
Publication date
01-04-2019
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 4/2019
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-019-04134-y

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