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Wang F, Qin Y, Wang ZM, Yan CY, He Y, Liu D, Wen L, Zhang D. A Dynamic Online Nomogram Based on Gd-EOB-DTPA-Enhanced MRI and Inflammatory Biomarkers for Preoperative Prediction of Pathological Grade and Stratification in Solitary Hepatocellular Carcinoma: A Multicenter Study. Acad Radiol 2024:S1076-6332(24)00126-0. [PMID: 38494348 DOI: 10.1016/j.acra.2024.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/24/2023] [Accepted: 02/22/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is an inflammatory cancer. We aimed to explore whether preoperative inflammation biomarkers compared to the gadoxetic acid disodium (Gd-EOB-DTPA) enhanced MRI can add complementary value for predicting HCC pathological grade, and to develop a dynamic nomogram to predict solitary HCC pathological grade. METHODS 331 patients from the Institution A were divided chronologically into the training cohort (n = 231) and internal validation cohort (n = 100), and recurrence-free survival (RFS) was determined to follow up after surgery. 79 patients from the Institution B served as the external validation cohort. Overall, 410 patients were analyzed as the complete dataset cohort. Least absolute shrinkage and selection operator (LASSO) and multivariate Logistic regression were used to gradually filter features for model construction. The area under the receiver operating characteristic curve (AUC) and decision curve analysis were used to evaluate model's performance. RESULTS Five models of the inflammation, imaging, inflammation+AFP, inflammation+imaging and nomogram were developed. Adding inflammation to imaging model can improve the AUC in training cohort (from 0.802 to 0.869), internal validation cohort (0.827 to 0.870), external validation cohort (0.740 to 0.802) and complete dataset cohort (0.739 to 0.788), and obtain more net benefit. The nomogram had excellent performance for predicting high-grade HCC in four cohorts (AUCs: 0.882 vs. 0.869 vs. 0.829 vs. 0.806) with a good calibration, and accessed at https://predict-solitaryhccgrade.shinyapps.io/DynNomapp/. Additionally, the nomogram obtained an AUC of 0.863 (95% CI 0.797-0.913) for predicting high-grade HCC in the HCC≤ 3 cm. Kaplan-Meier survival curves demonstrated that the nomogram owned excellent stratification for HCC grade (P < 0.0001). CONCLUSION This easy-to-use dynamic online nomogram hold promise for use as a noninvasive tool in prediction HCC grade with high accuracy and robustness.
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Affiliation(s)
- Fei Wang
- Department of Radiology, XinQiao Hospital of Army Medical University, No.83, Xinqiao Central Street, Shapingba District, Chongqing 400037, China
| | - Yuan Qin
- Department of Radiology, Chongqing University Three Gorges Hospital, No.165, Xincheng Road, Wanzhou District, Chongqing 404031, China
| | - Zheng Ming Wang
- Department of Radiology, XinQiao Hospital of Army Medical University, No.83, Xinqiao Central Street, Shapingba District, Chongqing 400037, China
| | - Chun Yue Yan
- Department of gynaecology and obstetrics, Luzhou People's Hospital, No.316, Jiugu Avenue, Jiangyang District, Luzhou 646000, China
| | - Ying He
- Department of Radiology, XinQiao Hospital of Army Medical University, No.83, Xinqiao Central Street, Shapingba District, Chongqing 400037, China
| | - Dan Liu
- Department of Radiology, XinQiao Hospital of Army Medical University, No.83, Xinqiao Central Street, Shapingba District, Chongqing 400037, China
| | - Li Wen
- Department of Radiology, XinQiao Hospital of Army Medical University, No.83, Xinqiao Central Street, Shapingba District, Chongqing 400037, China
| | - Dong Zhang
- Department of Radiology, XinQiao Hospital of Army Medical University, No.83, Xinqiao Central Street, Shapingba District, Chongqing 400037, China.
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Chen H, Yang R, Yu X, Li K, Xue P, Peng W, Zeng P. Development of a Nomogram Using the Inflammatory Risk Score for Prognostication in Moderate and Advanced Hepatocellular Carcinoma Associated with Hepatitis B Virus. Balkan Med J 2024; 41:130-138. [PMID: 38425017 PMCID: PMC10913116 DOI: 10.4274/balkanmedj.galenos.2024.2023-12-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 02/16/2024] [Indexed: 03/02/2024] Open
Abstract
Background The changes in risk scores of inflammatory markers among patients diagnosed with hepatocellular carcinoma (HCC) remain unknown. Aims To investigate the relationship between the inflammation risk score and other contributing factors and the prognostic outcomes in patients with moderate and advanced hepatitis B virus (HBV)-related HCC. Study Design A retrospective cohort study. Methods A total of 174 patients with moderate and advanced HBV related HCC were recruited to investigate the impact of stratified inflammatory risk scores and other associated risk factors on disease prognosis. Based on the optimal cut-off values calculated by the Youden index, the patients were divided into high-risk and low-risk groups based on their inflammation risk scores. Results The study found a significant difference in median survival time between the low-risk and high-risk groups based on the inflammation risk score. Furthermore, the inflammation risk score, alpha-fetoprotein levels, transarterial chemoembolization treatment, and Barcelona Clinic Liver Cancer stage were identified as independent prognostic factors. The four variables were used to construct a prognostic nomogram for HCC. Subsequent evaluations using time-dependent receiver operating characteristic analysis and calibration curve tests revealed the nomogram's commendable discriminatory ability. As a result, the nomogram proved to be an effective tool for predicting survival at 2- to 4-years. Conclusion The inflammation risk score has been identified as a significant prognostic factor for HBV-related HCC. The development of nomogram models has provided a practical and effective tool for determining the prognosis of patients affected by HBV-related HCC.
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Affiliation(s)
- Hongyao Chen
- Hunan Provincial Hospital of Integrated Traditional Chinese and Western, Cancer Research Institute of Hunan Academy of Traditional Chinese Medicine, Hunan Academy of Chinese Medicine, Hunan, China
- Hunan University of Chinese Medicine, Hunan, China
| | - Renyi Yang
- Hunan Provincial Hospital of Integrated Traditional Chinese and Western, Cancer Research Institute of Hunan Academy of Traditional Chinese Medicine, Hunan Academy of Chinese Medicine, Hunan, China
- Hunan University of Chinese Medicine, Hunan, China
| | - Xiaopeng Yu
- Hunan Provincial Hospital of Integrated Traditional Chinese and Western, Cancer Research Institute of Hunan Academy of Traditional Chinese Medicine, Hunan Academy of Chinese Medicine, Hunan, China
| | - Kexiong Li
- Hunan Provincial Hospital of Integrated Traditional Chinese and Western, Cancer Research Institute of Hunan Academy of Traditional Chinese Medicine, Hunan Academy of Chinese Medicine, Hunan, China
| | - Peisen Xue
- Hunan University of Chinese Medicine, Hunan, China
| | - Wei Peng
- Hunan Provincial Hospital of Integrated Traditional Chinese and Western, Cancer Research Institute of Hunan Academy of Traditional Chinese Medicine, Hunan Academy of Chinese Medicine, Hunan, China
| | - Puhua Zeng
- Hunan Provincial Hospital of Integrated Traditional Chinese and Western, Cancer Research Institute of Hunan Academy of Traditional Chinese Medicine, Hunan Academy of Chinese Medicine, Hunan, China
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Zheng X, Xu YJ, Huang J, Cai S, Wang W. Predictive value of radiomics analysis of enhanced CT for three-tiered microvascular invasion grading in hepatocellular carcinoma. Med Phys 2023; 50:6079-6095. [PMID: 37517073 DOI: 10.1002/mp.16597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 05/22/2023] [Accepted: 06/07/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Microvascular invasion (MVI) is a major risk factor, for recurrence and metastasis of hepatocellular carcinoma (HCC) after radical surgery and liver transplantation. However, its diagnosis depends on the pathological examination of the resected specimen after surgery; therefore, predicting MVI before surgery is necessary to provide reference value for clinical treatment. Meanwhile, predicting only the existence of MVI is not enough, as it ignores the degree, quantity, and distribution of MVI and may lead to MVI-positive patients suffering due to inappropriate treatment. Although some studies have involved M2 (high risk of MVI), majority have adopted the binary classification method or have not included radiomics. PURPOSE To develop three-class classification models for predicting the grade of MVI of HCC by combining enhanced computed tomography radiomics features with clinical risk factors. METHODS The data of 166 patients with HCC confirmed by surgery and pathology were analyzed retrospectively. The patients were divided into the training (116 cases) and test (50 cases) groups at a ratio of 7:3. Of them, 69 cases were MVI positive in the training group, including 45 cases in the low-risk group (M1) and 24 cases in the high-risk group (M2), and 47 cases were MVI negative (M0). In the training group, the optimal subset features were obtained through feature selection, and the arterial phase radiomics model, portal venous phase radiomics model, delayed phase radiomics model, three-phase radiomics model, clinical imaging model, and combined model were developed using Linear Support Vector Classification. The test group was used for validation, and the efficacy of each model was evaluated through the receiver operating characteristic curve (ROC). RESULTS The clinical imaging features of MVI included alpha-fetoprotein, tumor size, tumor margin, peritumoral enhancement, intratumoral artery, and low-density halo. The area under the curve (AUC) of the ROC values of the clinical imaging model for M0, M1, and M2 were 0.831, 0.701, and 0.847, respectively, in the training group and 0.782, 0.534, and 0.785, respectively, in the test group. After combined radiomics analyis, the AUC values for M0, M1, and M2 in the test group were 0.818, 0.688, and 0.867, respectively. The difference between the clinical imaging model and the combined model was statistically significant (p = 0.029). CONCLUSION The clinical imaging model and radiomics model developed in this study had a specific predictive value for HCC MVI grading, which can provide precise reference value for preoperative clinical diagnosis and treatment. The combined application of the two models had a high predictive efficacy.
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Affiliation(s)
- Xin Zheng
- Department of Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
- Department of Radiology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Yun-Jun Xu
- Department of Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Jingcheng Huang
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Shengxian Cai
- Department of Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Wanwan Wang
- Department of Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
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Yu X, Yang R, He Z, Zeng P. Construction and validation of a nomogram for hepatocellular carcinoma patients treated by traditional Chinese medicine based on inflammation, nutrition, and blood lipid indicators. J Cancer Res Clin Oncol 2023:10.1007/s00432-023-04830-y. [PMID: 37160627 DOI: 10.1007/s00432-023-04830-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 04/30/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE To establish a nomogram for hepatocellular carcinoma (HCC) patients treated by traditional Chinese medicine (TCM). METHODS Clinical cases of HCC patients treated by TCM at Hunan Integrated Traditional Chinese and Western Medicine Hospital, and it was randomly divided into the training cohort (n = 222) and the validation cohort (n = 95). In the training cohort, independent risk factors were determined by Cox regression analysis and a nomogram was constructed. The efficiency and clinical applicability of nomograms were evaluated using time-dependent curves, calibration, and the decision curve (DCA), and the patients were divided into high-risk, middle-risk and low-risk groups using X-tile software. RESULTS Multivariate Cox regression analysis screened 6 independent risk factors to construct a nomogram of HCC patients, including TNM stage, treatment methods, high-density lipoprotein (HDL), neutrophil-to-lymphocyte ratio (NLR), albumin-to-globulin ratio (AGR), and prognostic nutritional index (PNI). The consistency index (C-index) of the nomogram of the training was 0.811 (0.794-0.829) and the validation cohort was 0.825 (0.800-0.849). The time dependency showed the AUC values of the nomogram for 3 and 5 years in training cohort were 0.894 (95% CI 0.840-0.948) and 0.952 (95% CI 0.914-0.990), and the validation cohort were 0.928 (95% CI 0.865-0.990) and 0.96 3(95% CI 0.916-1.010). The calibration plot showed the nomogram fits well onto perfect curves, and the DCA curve showed the net benefit of the nomogram at a certain probability threshold is significantly higher than the net benefit of the TNM stage at the same threshold probability. Finally, all the patients were divided into high-risk, middle-risk and low-risk groups based on the total score of nomogram, and it showed effectively how to identify to high-risk patients. CONCLUSION The nomogram established by the independent risk factors of TNM stage, treatment methods, HDL, AGR, NLR and PNI can predict the prognosis of HCC patients treated by TCM, providing an effective tool to clinical workers to evaluate the prognosis and survival time of HCC patients.
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Affiliation(s)
- Xiaopeng Yu
- Hunan University of Chinese Medicine, Changsha, 410208, Hunan, China
| | - Renyi Yang
- Hunan University of Chinese Medicine, Changsha, 410208, Hunan, China
| | - Zuomei He
- Hunan Academy of Traditional Chinese Medicine Affiliated Hospital, Changsha, 410006, Hunan, China.
- Cancer Research Institute of Hunan Academy of Traditional Chinese Medicine, Changsha, 410006, Hunan, China.
| | - Puhua Zeng
- Hunan Academy of Traditional Chinese Medicine Affiliated Hospital, Changsha, 410006, Hunan, China.
- Cancer Research Institute of Hunan Academy of Traditional Chinese Medicine, Changsha, 410006, Hunan, China.
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He T, Zou J, Sun K, Yang J, Lei T, Xu L, Liu J, Yin S, Li G. Global research status and frontiers on microvascular invasion of hepatocellular carcinoma: A bibliometric and visualized analysis. Front Oncol 2022; 12:1037145. [PMID: 36591459 PMCID: PMC9795233 DOI: 10.3389/fonc.2022.1037145] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Over the past decade, several studies on the microvascular invasion (MVI) of hepatocellular carcinoma (HCC) have been published. However, they have not quantitatively analyzed the remarkable impact of MVI. Therefore, a more comprehensive understanding of the field is now needed. This study aims to analyze the evolution of HCC-MVI research and to systematically evaluate the scientific outputs using bibliometric citation analysis. Methods A systematic search was conducted on the Web of Science Core Collection on 2 May 2022 to retrieve studies on HCC-MVI published between 2013 and 2022. Then, a bibliometric analysis of the publications was performed using CiteSpace, VOSviewer, and other visualization tools. Results A total of 1,208 articles on HCC MVI were identified. Of these, China (n = 518) was the most prolific country, and Fudan University (n = 90) was the most notable institution. Furthermore, we observed that Lau Wan Yee participated in most studies (n = 26), and Frontiers in Oncology (IF2020:6.24) published the highest number of documents (n = 49) on this subject, with 138 publications. The paper "Bray F, 2018, CA-CANCER J CLIN, V68, P394" has the highest number of co-cited references, with 119 citations. In addition, the top three keywords were "survival", "recurrence", and "microvascular invasion". Moreover, the research hot spots and frontiers of HCC-MVI for the last 3 years included imaging characteristics and transarterial chemoembolization (TACE) therapy studies. Conclusions This study comprehensively summarized the most significant HCC-MVI documents from past literature and highlighted key contributions made to the advancement of this subject and the advancement of this field over the past decade. The trend of MVI research will gradually shift from risk factors and prognosis studies to imaging characteristics and TACE therapy studies.
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Affiliation(s)
- Tao He
- Department of Hepatobiliary Surgery, Chengdu Second People’s Hospital, Chengdu, Sichuan, China,*Correspondence: Tao He,
| | - Jieyu Zou
- Depatment of Oncology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ke Sun
- Department of Hepatobiliary Surgery, Chengdu Second People’s Hospital, Chengdu, Sichuan, China
| | - Juan Yang
- Department of Hepatobiliary Surgery, Chengdu Second People’s Hospital, Chengdu, Sichuan, China
| | - Tingting Lei
- Department of Hepatobiliary Surgery, Chengdu Second People’s Hospital, Chengdu, Sichuan, China
| | - Lin Xu
- Department of Hepatobiliary Surgery, Chengdu Second People’s Hospital, Chengdu, Sichuan, China
| | - Jinheng Liu
- Department of Hepatobiliary Surgery, Chengdu Second People’s Hospital, Chengdu, Sichuan, China
| | - Sineng Yin
- Department of Hepatobiliary Surgery, Chengdu Second People’s Hospital, Chengdu, Sichuan, China
| | - Guangkuo Li
- Department of Hepatobiliary Surgery, Chengdu Second People’s Hospital, Chengdu, Sichuan, China
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Gu Y, Zheng F, Zhang Y, Qiao S. Novel Nomogram Based on Inflammatory Markers for the Preoperative Prediction of Microvascular Invasion in Solitary Primary Hepatocellular Carcinoma. Cancer Manag Res 2022; 14:895-907. [PMID: 35256861 PMCID: PMC8898018 DOI: 10.2147/cmar.s346976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 02/15/2022] [Indexed: 01/01/2023] Open
Abstract
Purpose We aimed to develop and to validate a novel nomogram based on inflammatory markers to preoperatively predict microvascular invasion (MVI) in patients with solitary primary hepatocellular carcinoma (HCC). Patients and Methods Data from 658 patients with solitary primary HCC who underwent hepatectomy at the First Affiliated Hospital of Zhengzhou University from June 2018 to October 2021 were retrospectively analyzed. Patients were divided into training (n=441) and validation (n=217) cohorts according to surgical data. Independent risk factors for MVI were identified via univariate and multivariate logistic regression analyses in the training cohort. A novel nomogram was developed based on the independent risk factors identified. Its accuracy was evaluated using a calibration curve and concordance index (C-index). The predictive value was evaluated using the receiver operating characteristic (ROC) curve and decision curve analysis (DCA). Results Preoperative alpha-fetoprotein >969 µg/L (P<0.001), tumor size (P=0.002), neutrophil >1.8×109/L (P=0.002), gamma-glutamyl transpeptidase-to-platelet ratio (GPR) >0.32 (P=0.001), aspartate aminotransferase-to-platelet ratio (APR) >0.18 (P<0.001), gamma-glutamyl transpeptidase-to-albumin ratio (GAR) >2.30 (P=0.001), and gamma-glutamyl transpeptidase-to-lymphocyte ratio >29.58 (P<0.001) were identified as preoperative independent risk factors for MVI and were used to establish the nomogram. The C-index of the training and validation cohorts were 0.788 (95% confidence interval [CI]: 0.744–0.831) and 0.735 (95% CI: 0.668–0.802), respectively. The calibration curve analysis revealed that the standard curve fit well with the predicted curve. ROC curve analysis demonstrated high efficiency of the nomogram. DCA verified that the nomogram had notable clinical value. Conclusion Preoperative GPR >0.32, APR >0.18, and GAR >2.30 were independent risk factors for MVI in patients with solitary primary HCC, suggesting their utility as preoperative predictors of MVI. The novel nomogram developed and validated in this study may aid in determining optimal therapeutic approaches for patients with solitary HCC at risk for MVI.
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Affiliation(s)
- Yufei Gu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, People’s Republic of China
| | - Fengyu Zheng
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, People’s Republic of China
| | - Yingxuan Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, People’s Republic of China
| | - Shishi Qiao
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, People’s Republic of China
- Correspondence: Shishi Qiao, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Zhengzhou University, No. 50 Jianshe East Road, Erqi District, Zhengzhou City, Henan Province, People’s Republic of China, Tel +86 18595811956, Email
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Immunological Markers, Prognostic Factors and Challenges Following Curative Treatments for Hepatocellular Carcinoma. Int J Mol Sci 2021; 22:ijms221910271. [PMID: 34638613 PMCID: PMC8508906 DOI: 10.3390/ijms221910271] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 01/27/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortalities worldwide. Patients with early-stage HCC are eligible for curative treatments, such as surgical resection, liver transplantation (LT) and percutaneous ablation. Although curative treatments provide excellent long-term survival, almost 70–80% of patients experience HCC recurrence after curative treatments. Tumor-related factors, including tumor size, number and differentiation, and underlying liver disease, are well-known risk factors for recurrence following curative therapies. Moreover, the tumor microenvironment (TME) also plays a key role in the recurrence of HCC. Many immunosuppressive mechanisms, such as an increase in regulatory T cells and myeloid-derived suppressor cells with a decrease in cytotoxic T cells, are implicated in HCC recurrence. These suppressive TMEs are also modulated by several factors and pathways, including mammalian target of rapamycin signaling, vascular endothelial growth factor, programmed cell death protein 1 and its ligand 1. Based on these mechanisms and the promising results of immune checkpoint blockers (ICBs) in advanced HCC, there have been several ongoing adjuvant studies using a single or combination of ICB following curative treatments in HCC. In this review, we strive to provide biologic and immunological markers, prognostic factors, and challenges associated with clinical outcomes after curative treatments, including resection, LT and ablation.
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Gundlach JP, Schmidt S, Bernsmeier A, Günther R, Kataev V, Trentmann J, Schäfer JP, Röcken C, Becker T, Braun F. Indication of Liver Transplantation for Hepatocellular Carcinoma Should Be Reconsidered in Case of Microvascular Invasion and Multilocular Tumor Occurrence. J Clin Med 2021; 10:jcm10061155. [PMID: 33801887 PMCID: PMC7998779 DOI: 10.3390/jcm10061155] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/21/2021] [Accepted: 03/03/2021] [Indexed: 02/07/2023] Open
Abstract
Liver transplantation (LT) is routinely performed for hepatocellular carcinoma (HCC) in cirrhosis without major vascular invasion. Although the adverse influence of microvascular invasion is recognized, its occurrence does not contraindicate LT. We retrospectively analyzed in our LT cohort the significance of microvascular invasion on survival and demonstrate bridging procedures. At our hospital, 346 patients were diagnosed with HCC, 171 patients were evaluated for LT, and 153 were listed at Eurotransplant during a period of 11 years. Among these, 112 patients received LT and were included in this study. Overall survival after 1, 3 and 5 years was 86.3%, 73.9%, and 67.9%, respectively. Microvascular invasion led to significantly reduced overall (p = 0.030) and disease-free survival (p = 0.002). Five-year disease-free survival with microvascular invasion was 10.5%. Multilocular tumor occurrence with simultaneous microvascular invasion revealed the worst prognosis. In our LT cohort, predominant bridging treatment was transarterial chemoembolization (TACE) and the number of TACE significantly correlated with poorer overall survival after LT (p = 0.028), which was confirmed in multiple Cox regression analysis for overall and disease-free survival (p = 0.015 and p = 0.011). Microvascular tumor invasion is significantly associated with reduced prognosis after LT, which is aggravated by simultaneous occurrence of multiple lesions. Therefore, indication strategies for LT should be reconsidered.
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Affiliation(s)
- Jan-Paul Gundlach
- Department of General, Visceral-, Thoracic-, Transplantation- and Pediatric Surgery, Campus Kiel, University Medical Center Schleswig-Holstein (UKSH), Arnold-Heller-Strasse 3, 24105 Kiel, Germany; (S.S.); (A.B.); (T.B.); (F.B.)
- Correspondence: ; Tel.: +49-431-500-33421
| | - Stephan Schmidt
- Department of General, Visceral-, Thoracic-, Transplantation- and Pediatric Surgery, Campus Kiel, University Medical Center Schleswig-Holstein (UKSH), Arnold-Heller-Strasse 3, 24105 Kiel, Germany; (S.S.); (A.B.); (T.B.); (F.B.)
| | - Alexander Bernsmeier
- Department of General, Visceral-, Thoracic-, Transplantation- and Pediatric Surgery, Campus Kiel, University Medical Center Schleswig-Holstein (UKSH), Arnold-Heller-Strasse 3, 24105 Kiel, Germany; (S.S.); (A.B.); (T.B.); (F.B.)
| | - Rainer Günther
- Department of Internal Medicine I, UKSH, Campus Kiel, Arnold-Heller-Strasse 3, 24105 Kiel, Germany; (R.G.); (V.K.)
| | - Victor Kataev
- Department of Internal Medicine I, UKSH, Campus Kiel, Arnold-Heller-Strasse 3, 24105 Kiel, Germany; (R.G.); (V.K.)
| | - Jens Trentmann
- Institute of Radiology and Neuroradiology, UKSH, Campus Kiel, Arnold-Heller-Strasse 3, 24105 Kiel, Germany; (J.T.); (J.P.S.)
| | - Jost Philipp Schäfer
- Institute of Radiology and Neuroradiology, UKSH, Campus Kiel, Arnold-Heller-Strasse 3, 24105 Kiel, Germany; (J.T.); (J.P.S.)
| | - Christoph Röcken
- Department of Pathology, UKSH, Campus Kiel, Arnold-Heller-Strasse 3, 24105 Kiel, Germany;
| | - Thomas Becker
- Department of General, Visceral-, Thoracic-, Transplantation- and Pediatric Surgery, Campus Kiel, University Medical Center Schleswig-Holstein (UKSH), Arnold-Heller-Strasse 3, 24105 Kiel, Germany; (S.S.); (A.B.); (T.B.); (F.B.)
| | - Felix Braun
- Department of General, Visceral-, Thoracic-, Transplantation- and Pediatric Surgery, Campus Kiel, University Medical Center Schleswig-Holstein (UKSH), Arnold-Heller-Strasse 3, 24105 Kiel, Germany; (S.S.); (A.B.); (T.B.); (F.B.)
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Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as predictors of tumor response in hepatocellular carcinoma after DEB-TACE. Eur Radiol 2020; 30:5663-5673. [PMID: 32424595 DOI: 10.1007/s00330-020-06931-5] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 03/15/2020] [Accepted: 04/30/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To investigate the predictive value of quantifiable imaging and inflammatory biomarkers in patients with hepatocellular carcinoma (HCC) for the clinical outcome after drug-eluting bead transarterial chemoembolization (DEB-TACE) measured as volumetric tumor response and progression-free survival (PFS). METHODS This retrospective study included 46 patients with treatment-naïve HCC who received DEB-TACE. Laboratory work-up prior to treatment included complete and differential blood count, liver function, and alpha-fetoprotein levels. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were correlated with radiomic features extracted from pretreatment contrast-enhanced magnetic resonance imaging (MRI) and with tumor response according to quantitative European Association for the Study of the Liver (qEASL) criteria and progression-free survival (PFS) after DEB-TACE. Radiomic features included single nodular tumor growth measured as sphericity, dynamic contrast uptake behavior, arterial hyperenhancement, and homogeneity of contrast uptake. Statistics included univariate and multivariate linear regression, Cox regression, and Kaplan-Meier analysis. RESULTS Accounting for laboratory and clinical parameters, high baseline NLR and PLR were predictive of poorer tumor response (p = 0.014 and p = 0.004) and shorter PFS (p = 0.002 and p < 0.001). When compared to baseline imaging, high NLR and PLR correlated with non-spherical tumor growth (p = 0.001 and p < 0.001). CONCLUSIONS This study establishes the prognostic value of quantitative inflammatory biomarkers associated with aggressive non-spherical tumor growth and predictive of poorer tumor response and shorter PFS after DEB-TACE. KEY POINTS • In treatment-naïve hepatocellular carcinoma (HCC), high baseline platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) are associated with non-nodular tumor growth measured as low tumor sphericity. • High PLR and NLR are predictive of poorer volumetric enhancement-based tumor response and PFS after DEB-TACE in HCC. • This set of readily available, quantitative immunologic biomarkers can easily be implemented in clinical guidelines providing a paradigm to guide and monitor the personalized application of loco-regional therapies in HCC.
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Yan Y, Zhou Q, Zhang M, Liu H, Lin J, Liu Q, Shi B, Wen K, Chen R, Wang J, Mao K, Xiao Z. Integrated Nomograms for Preoperative Prediction of Microvascular Invasion and Lymph Node Metastasis Risk in Hepatocellular Carcinoma Patients. Ann Surg Oncol 2019; 27:1361-1371. [PMID: 31773517 DOI: 10.1245/s10434-019-08071-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND The aim of the present work is to develop and validate accurate preoperative nomograms to predict microvascular invasion (MVI) and lymph node metastasis (LNM) in hepatocellular carcinoma. PATIENTS AND METHODS A total of 268 patients with resected hepatocellular carcinoma (HCC) were divided into a training set (n = 180), in an earlier period, and a validation set (n = 88), thereafter. Risk factors for MVI and LNM were assessed based on logistic regression. Blood signatures were established using the least absolute shrinkage and selection operator algorithm. Nomograms were constructed by combining risk factors and blood signatures. Performance was evaluated using the training set and validated using the validation set. The clinical values of the nomograms were measured by decision curve analysis. RESULTS The risk factors for MVI were hepatitis B virus (HBV) DNA loading, portal hypertension, Barcelona liver clinic (BCLC) stage, and three computerized tomography (CT) imaging features, namely tumor number, size, and encapsulation, while only BCLC stage, Child-Pugh classification, and tumor encapsulation were associated with LNM. The nomogram incorporating both risk factors and blood signatures achieved better performance in predicting MVI in the training and validation sets (C-indexes of 0.828 and 0.804) than the LNM nomogram (C-indexes of 0.765 and 0.717). Calibration curves also demonstrated a good fit. The decision curves indicate significant clinical usefulness. CONCLUSIONS The novel validated nomograms for HCC patients presented herein are noninvasive preoperative tools that can effectively predict the individualized risk of MVI and LNM, and this predictive power can aid doctors in explaining the illness for patient counseling.
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Affiliation(s)
- Yongcong Yan
- Department of Hepatobiliary Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.,RNA Biomedical Institute, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Qianlei Zhou
- Department of Hepatobiliary Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.,RNA Biomedical Institute, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Mengyu Zhang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Haohan Liu
- Department of Hepatobiliary Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.,RNA Biomedical Institute, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jianhong Lin
- Department of Hepatobiliary Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.,RNA Biomedical Institute, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Qinghua Liu
- Department of Hepatobiliary Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.,RNA Biomedical Institute, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Bingchao Shi
- Department of Hepatobiliary Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.,RNA Biomedical Institute, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Kai Wen
- Department of Hepatobiliary Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.,RNA Biomedical Institute, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ruibin Chen
- Department of Hepatobiliary Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.,RNA Biomedical Institute, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jie Wang
- Department of Hepatobiliary Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Kai Mao
- Department of Hepatobiliary Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
| | - Zhiyu Xiao
- Department of Hepatobiliary Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
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11
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Deng G, Yao L, Zeng F, Xiao L, Wang Z. Nomogram For Preoperative Prediction Of Microvascular Invasion Risk In Hepatocellular Carcinoma. Cancer Manag Res 2019; 11:9037-9045. [PMID: 31695495 PMCID: PMC6816236 DOI: 10.2147/cmar.s216178] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 09/10/2019] [Indexed: 12/24/2022] Open
Abstract
Objective To preoperatively predict the microvascular invasion (MVI) risk in hepatocellular carcinoma (HCC) using nomogram. Methods A retrospective cohort of 513 patients with HCC hospitalized at Xiangya Hospital between January 2014 and December 2018 was included in the study. Univariate and multivariate analysis was performed to identify the independent risk factors for MVI. Based on the independent risk factors, nomogram was established to preoperatively predict the MVI risk in HCC. The accuracy of nomogram was evaluated by using receiver operating characteristic (ROC) curve, calibration curve and decision curve analysis (DCA). Results Tumor size (OR=1.17, 95% CI: 1.11–1.23, p<0.001), preoperative AFP level greater than 155 ng/mL (OR=1.65, 95% CI: 1.13–2.39, p=0.008) and NLR (OR=1.14, 95% CI: 1.00–1.29, p=0.042) were the independent risk factors for MVI. Incorporating these 3 factors, nomogram was established with the concordance index of 0.71 (95% CI, 0.66–0.75) and well-fitted calibration curves. DCA confirmed that using this nomogram added more benefit compared with the measures that treat all patients or treat none patients. At the cutoff value of predicted probability ≥0.44, the model demonstrated sensitivity of 61.64%, specificity of 71.53%, positive predictive value (PPV) of 64.13%, and negative predictive value (NPV) of 69.31%. Conclusion Nomogram was established for preoperative prediction of the MVI risk in HCC patients, and better therapeutic choice will be made if it was applied in clinical practice.
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Affiliation(s)
- Guangtong Deng
- General Surgery Department, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Lei Yao
- General Surgery Department, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Furong Zeng
- Xiangya School of Medicine, Central South University, Changsha, People's Republic of China
| | - Liang Xiao
- General Surgery Department, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Zhiming Wang
- General Surgery Department, Xiangya Hospital, Central South University, Changsha, People's Republic of China
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12
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Chen ZH, Zhang XP, Wang H, Chai ZT, Sun JX, Guo WX, Shi J, Cheng SQ. Effect of microvascular invasion on the postoperative long-term prognosis of solitary small HCC: a systematic review and meta-analysis. HPB (Oxford) 2019; 21:935-944. [PMID: 30871805 DOI: 10.1016/j.hpb.2019.02.003] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 01/26/2019] [Accepted: 02/04/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The effect of microvascular invasion (MVI) on the postoperative long-term prognosis of solitary small hepatocellular carcinoma remains controversial. We compared the long-term outcomes of MVI-positive and MVI-negative groups of patients with solitary small hepatocellular carcinoma. METHODS The PubMed, EMBASE, Cochrane Library, VIP, Wan Fang, and Sino Med databases were systematically searched to compare the long-term outcomes of MVI-positive and MVI-negative groups of patients with solitary small hepatocellular carcinoma from inception to November 1, 2018. The study outcomes, including overall survival (OS) and disease-free survival (DFS), were extracted independently by two authors. RESULTS Fourteen studies involving 3033 patients were evaluated. A meta-analysis of all 14 studies suggested that the OS of the MVI-positive group was significantly worse than that of the MVI-negative group (HR = 2.39, 95% CI = 2.02-2.84, I2 = 22.8%; P < 0.001). Twelve studies were included in the meta-analysis of DFS, and MVI showed a worse prognosis (HR = 1.79, 95% CI = 1.59-2.02, I2 = 25.3%; P < 0.001). Subgroup analysis demonstrated that MVI still showed a negative effect on the long-term OS and DFS of patients with solitary small HCC measuring up to 2 cm, 3 cm, or 5 cm. CONCLUSION Microvascular invasion was a risk factor for poorer prognosis for solitary small hepatocellular carcinoma.
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Affiliation(s)
- Zhen-Hua Chen
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Xiu-Ping Zhang
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Hang Wang
- Company 8 of Student Bridge, Second Military Medical University, Shanghai, China
| | - Zong-Tao Chai
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Ju-Xian Sun
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Wei-Xing Guo
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Jie Shi
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Shu-Qun Cheng
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
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13
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Balaceanu LA. Biomarkers vs imaging in the early detection of hepatocellular carcinoma and prognosis. World J Clin Cases 2019; 7:1367-1382. [PMID: 31363465 PMCID: PMC6656675 DOI: 10.12998/wjcc.v7.i12.1367] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/07/2019] [Accepted: 05/03/2019] [Indexed: 02/05/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the 5th most frequently diagnosed cancer in the world, according to the World Health Organization. The incidence of HCC is between 3/100000 and 78.1/100000, with a high incidence reported in areas with viral hepatitis B and hepatitis C, thus affecting Asia and Africa predominantly. Several international clinical guidelines address HCC diagnosis and are structured according to the geographical area involved. All of these clinical guidelines, however, share a foundation of diagnosis by ultrasound surveillance and contrast imaging techniques, particularly computed tomography, magnetic resonance imaging, and sometimes contrast-enhanced ultrasound. The primary objective of this review was to systematically summarize the recent published studies on the clinical utility of serum biomarkers in the early diagnosis of HCC and for the prognosis of this disease.
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Affiliation(s)
- Lavinia Alice Balaceanu
- Department of Internal Medicine, Carol Davila University of Medicine and Pharmacy, Sf. Ioan Clinical Emergency Hospital, Bucharest 42122, Romania
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14
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Erstad DJ, Tanabe KK. Prognostic and Therapeutic Implications of Microvascular Invasion in Hepatocellular Carcinoma. Ann Surg Oncol 2019; 26:1474-1493. [PMID: 30788629 DOI: 10.1245/s10434-019-07227-9] [Citation(s) in RCA: 239] [Impact Index Per Article: 47.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Indexed: 02/06/2023]
Abstract
Hepatocellular carcinoma (HCC) is a morbid condition for which surgical and ablative therapy are the only options for cure. Nonetheless, over half of patients treated with an R0 resection will develop recurrence. Early recurrences within 2 years after resection are thought to be due to the presence of residual microscopic disease, while late recurrences > 2 years after resection are thought to be de novo metachronous HCCs arising in chronically injured liver tissue. Microvascular invasion (MVI) is defined as the presence of micrometastatic HCC emboli within the vessels of the liver, and is a critical determinant of early recurrence and survival. In this review, we summarize the pathogenesis and clinical relevance of MVI, which correlates with adverse biological features, including high grade, large tumor size, and epithelial-mesenchymal transition. Multiple classification schemas have been proposed to capture the heterogeneous features of MVI that are associated with prognosis. However, currently, MVI can only be determined based on surgical specimens, limiting its clinical applicability. Going forward, advances in axial imaging technologies, molecular characterization of biopsy tissue, and novel serum biomarkers hold promise as future methods for non-invasive MVI detection. Ultimately, MVI status may be used to help clinicians determine treatment plans, particularly with respect to surgical intervention, and to provide more accurate prognostication.
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Affiliation(s)
- Derek J Erstad
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Kenneth K Tanabe
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA.
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15
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Wong L, Bozhilov K, Hernandez B, Kwee S, Chan O, Ellis L, LeMarchand L. Underlying liver disease and advanced stage liver cancer are associated with elevated neutrophil-lymphocyte ratio. Clin Mol Hepatol 2019; 25:305-316. [PMID: 31001964 PMCID: PMC6759430 DOI: 10.3350/cmh.2019.0004] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 02/15/2019] [Indexed: 02/07/2023] Open
Abstract
Background/Aims Inflammation-based scores, such as the neutrophil-to-lymphocyte ratio (NLR), have been associated with prognosis in hepatocellular carcinoma (HCC); but variable cut-off values and potential lack of specificity have limited the utility of NLR. This study evaluates NLR in a large cohort of HCC patients. Methods We retrospectively reviewed 789 HCC cases (1993–2017) for demographics, tumor characteristics, treatment, and survival. NLR was stratified into NLR ≥1.5 and NLR ≥3 and analyzed for correlation with American Joint Committee on Cancer (AJCC) and Barcelona Clinic Liver Cancer (BCLC) stages. In 235 patients who underwent liver resection, survival and recurrence were evaluated by NLR. Results In 789 HCC cases, mean NLR was increased with advanced AJCC and BCLC stages. Hepatitis C patients were less likely to have NLR ≥1.5 and ≥3. Non-alcoholic steatohepatitis patients were more likely to have NLR ≥3. Patients with tumor size >5 cm, rupture, or macrovascular invasion were more likely to have NLR ≥3. In patients treated with resection, NLR ≥3 predicted early recurrence (odds ratio [OR] 4.14, P<0.01) and overall recurrence (OR 4.05, P<0.01). Mean NLR was 4.30 in those with recurrence and 2.75 in those without recurrence. Patients with NLR ≥3 showed significantly worse survival compared to those with NLR <3 (P<0.01 by log-rank test). Conclusions Elevated NLR is associated with advanced cancer stage and aggressive tumor characteristics, such as large size, rupture, and invasion. NLR ≥3 was associated with early and overall recurrence after resection but varied with etiology. NLR may be a useful biomarker in predicting recurrence for HCC patients undergoing curative resection, but further studies are required to elucidate the effect of disease etiology.
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Affiliation(s)
- Linda Wong
- Department of Surgery, University of Hawaii, Honolulu, HI, USA
| | | | | | - Sandi Kwee
- Positron Emission Tomography Research Center, The Queens Medical Center, Honolulu, HI, USA
| | - Owen Chan
- Cancer Center, University of Hawaii, Honolulu, HI, USA
| | - Luke Ellis
- Department of Surgery, University of Hawaii, Honolulu, HI, USA
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16
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Ke RS, Cai QC, Chen YT, Lv LZ, Jiang Y. Diagnosis and treatment of microvascular invasion in hepatocellular carcinoma. Eur Surg 2019. [DOI: 10.1007/s10353-019-0573-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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17
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Carr BI, Akkiz H, Guerra V, Üsküdar O, Kuran S, Karaoğullarından Ü, Tokmak S, Ballı T, Ülkü A, Akçam T, Delik A, Arslan B, Doran F, Yalçın K, Altntaş E, Özakyol A, Yücesoy M, Bahçeci Hİ, Polat KY, Ekinci N, Şimşek H, Örmeci N, Sonsuz A, Demir M, Kılıç M, Uygun A, Demir A, Yilmaz S, Tokat Y. C-reactive protein and hepatocellular carcinoma: analysis of its relationships to tumor factors. ACTA ACUST UNITED AC 2018; 15:625-634. [PMID: 29951199 DOI: 10.4172/clinical-practice.1000409] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
C-reactive protein (CRP) is a blood marker for inflammation and is an independent prognostic factor for many human cancers. Combined with albumin levels, it forms the basis of the Glasgow Index for cancer prognosis. We reviewed the literature on CRP and HCC and also evaluated blood CRP levels and combination CRP plus albumin levels in a large HCC cohort. In order to understand the prognostic significance of CRP, we retrospectively examined a large HCC cohort and examined the relationship of CRP levels to tumor parameters. We report, that CRP alone and CRP plus albumin combined as well, significantly correlated with parameters of HCC aggressiveness, such as maximum tumor dimension (MTD), portal vein thrombosis (PVT) and blood alpha-fetoprotein (AFP) levels, both as individual parameters and all parameters together (Aggressiveness Index). This extends current thinking, to suggest a possible explanation for the usefulness of blood CRP levels in HCC prognostication.
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Affiliation(s)
- Brian I Carr
- Izmir Biomedicine and Genome Institute, Dokuz Eylul University, Izmir, Turkey, and Liver
Transplant Institute, Inonu University, Malatya, Turkey
| | - Hikmet Akkiz
- Çukurova University Gastroenterology Department, Adana, Turkey
| | - Vito Guerra
- Trials Centre, National Institute for Digestive Diseases, IRCCS "Saverio de Bellis", Castellana, Bari, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ahmet Uygun
- Haydarpaşa sultan Abdülhamid Eğitm Araştrma Hastanesi, Turkey
| | - Ali Demir
- Konya Necmetn Erbakan Üniversitesi, Turkey
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