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Umar Garzali I, Carr BI, İnce V, Işık B, Nur Akatlı A, Yılmaz S. Microvascular Invasion in Hepatocellular Carcinoma: Some Puzzling Facets. THE TURKISH JOURNAL OF GASTROENTEROLOGY : THE OFFICIAL JOURNAL OF TURKISH SOCIETY OF GASTROENTEROLOGY 2024; 35:143-149. [PMID: 38454246 PMCID: PMC10895888 DOI: 10.5152/tjg.2024.22769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 03/27/2023] [Indexed: 03/09/2024]
Abstract
BACKGROUND/AIMS Hepatocellular carcinoma is the main type of primary liver cancer. Macroscopic vascular invasion is usually identified during imaging, whereas microvascular invasion is usually determined by histopathological evaluation. We aim to identify the association between microvascular invasion and other markers of tumor aggressiveness and to identify the role of microvascular invasion in the prognosis of patients who were treated by liver transplantation for hepatocellular carcinoma. MATERIALS AND METHODS This is a single-center retrospective analysis of prospectively collected data. Patients who received liver transplantation for hepatocellular carcinoma were included in the study. Data were collected regarding sociodemographic variables, criteria of selection for liver transplantation, pretransplant alpha-fetoprotein, presence or absence of microvascular invasion, presence or absence of recurrence, overall survival, and disease-free survival. Data were analyzed using Statistical Package for the Social Sciences. RESULTS Sociodemographic laboratory values and radiologic tumor characteristics were found to be similar in patients with or without microvascular invasion. Our study revealed that microvascular invasion is associated with increased recurrence, decreased diseasedfree survival, and decreased overall survival, only for patients with hepatocellular carcinoma beyond Milan criteria at the time of liver transplantation. CONCLUSION For patients beyond Milan criteria, but not within Milan criteria, microvascular invasion plays a significant role in predicting recurrence and shorter survival after liver transplantation.
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Affiliation(s)
- Ibrahim Umar Garzali
- Liver Transplant Institute, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Brian I. Carr
- Liver Transplant Institute, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Volkan İnce
- Liver Transplant Institute, İnönü University Faculty of Medicine, Malatya, Turkey
- Department of Surgery, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Burak Işık
- Liver Transplant Institute, İnönü University Faculty of Medicine, Malatya, Turkey
- Department of Surgery, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Ayşe Nur Akatlı
- Department of Pathology, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Sezai Yılmaz
- Liver Transplant Institute, İnönü University Faculty of Medicine, Malatya, Turkey
- Department of Surgery, İnönü University Faculty of Medicine, Malatya, Turkey
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Gundlach JP, Ellrichmann M, van Rosmalen M, Vogelaar S, Eimer C, Rheinbay C, Rösgen S, Schäfer JP, Becker T, Linecker M, Braun F. Liver transplantation for HCC in cirrhosis: Are Milan criteria outdated? ZEITSCHRIFT FUR GASTROENTEROLOGIE 2024; 62:43-49. [PMID: 38195107 PMCID: PMC10776328 DOI: 10.1055/a-2228-7496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/03/2023] [Indexed: 01/11/2024]
Abstract
In Germany, organ allocation is based on the MELD-system and lab-MELD is usually low in patients with hepatocellular carcinoma (HCC) in cirrhosis. Higher medical urgency can be achieved by standard exception for HCC (SE-HCC), if Milan criteria (MC) are met. Noteworthy, UNOS T2 reflects MC, but excludes singular lesions < 2 cm. Thus, SE-HCC is awarded to patients with one lesion between 2 and 5 cm or 2 to 3 lesions between 1 and 3 cm. These criteria are static and do not reflect biological properties of HCC.We present a retrospective cohort of 111 patients, who underwent liver transplantation at UKSH, Campus Kiel between 2007 and 2017. No difference was found in overall survival for patient cohorts using Milan, UCSF, up-to-seven, and French-AFP criteria. However, there was a significantly reduced survival, if microvascular invasion was detected in the explanted organ and in patients with HCC-recurrence. The exclusive use of static selection criteria including MC appear to limit the access to liver transplantation.
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Affiliation(s)
- Jan-Paul Gundlach
- Department of General, Visceral-, Thoracic-, Transplant- and Pediatric-Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Mark Ellrichmann
- Interdisciplinary Endoscopy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | - Serge Vogelaar
- Eurotransplantat International Foundation, Leiden, Netherlands
| | - Christine Eimer
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Corinna Rheinbay
- Department of General, Visceral-, Thoracic-, Transplant- and Pediatric-Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Sabina Rösgen
- Department of General, Visceral-, Thoracic-, Transplant- and Pediatric-Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jost-Philipp Schäfer
- Clinic for Radiology und Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Thomas Becker
- Department of General, Visceral-, Thoracic-, Transplant- and Pediatric-Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Michael Linecker
- Department of General, Visceral-, Thoracic-, Transplant- and Pediatric-Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Felix Braun
- Department of General, Visceral-, Thoracic-, Transplant- and Pediatric-Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Cha DI, Kang TW, Jeong WK, Kim JM, Choi GS, Joh JW, Yi NJ, Ahn SH. Preoperative assessment of microvascular invasion risk using gadoxetate-enhanced MRI for predicting outcomes after liver transplantation for single hepatocellular carcinoma within the Milan criteria. Eur Radiol 2024; 34:498-508. [PMID: 37505248 DOI: 10.1007/s00330-023-09936-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 05/10/2023] [Accepted: 05/15/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE To compare therapeutic outcomes after liver transplantation (LT) between hepatocellular carcinomas (HCC) with low and high risk for microvascular invasion (MVI) within the Milan criteria evaluated preoperatively. METHODS Eighty patients with a single HCC who underwent LT as the initial therapy between 2008 and 2017 were included from two tertiary referral medical centers in a HBV-predominant population. A preoperative MVI-risk model was used to identify low- and high-risk patients. Recurrence-free survival (RFS) after LT between the two risk groups was compared using Kaplan-Meier curves with the log-rank test. Prognostic factors for RFS were identified using a multivariable Cox hazard regression analysis. RESULTS Eighty patients were included (mean age, 51.8 years +/- 7.5 [standard deviation], 65 men). Patients were divided into low-risk (n = 64) and high-risk (n = 16) groups for MVI. The RFS rates after LT were significantly lower in the MVI high-risk group compared to the low-risk group at 1 year (75.0% [95% CI: 56.5-99.5%] vs. 96.9% [92.7-100%], p = 0.048), 3 years (62.5% [42.8-91.4%] vs. 95.3% [90.3-100%], p = 0.008), and 5 years (62.5% [42.8-91.4%] vs. and 95.3% [90.3-100%], p = 0.008). In addition, multivariable analysis showed that MVI high risk was the only significant factor for poor RFS (p = 0.016). CONCLUSION HCC patients with a high risk of MVI showed significantly lower RFS after LT than those without. This model could aid in selecting optimal candidates in addition to the Milan criteria when considering upfront LT for patients with HCC if alternative treatment options are available. CLINICAL RELEVANCE STATEMENT High risk for microvascular invasion (MVI) in hepatocellular carcinoma patients lowered recurrence-free survival after liver transplantation, despite meeting the Milan criteria. Identifying MVI risk could aid candidate selection for upfront liver transplantation, particularly if alternative treatments are available. KEY POINTS • A predictive model-derived microvascular invasion (MVI) high- and low-risk groups had a significant difference in the incidence of MVI on pathology. • Recurrence-free survival after liver transplantation (LT) for single hepatocellular carcinoma (HCC) within the Milan criteria was significantly different between the MVI high- and low-risk groups. • The peak incidence of tumor recurrence was 20 months after liver transplantation, probably indicating that HCC with high risk for MVI had a high risk of early (≤ 2 years) tumor recurrence.
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Affiliation(s)
- Dong Ik Cha
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Tae Wook Kang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
| | - Woo Kyoung Jeong
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gyu-Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae-Won Joh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Nam-Joon Yi
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Soo Hyun Ahn
- Department of Mathematics, Ajou University, Suwon, Republic of Korea
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Lévi-Strauss T, Tortorici B, Lopez O, Viau P, Ouizeman DJ, Schall B, Adhoute X, Humbert O, Chevallier P, Gual P, Fillatre L, Anty R. Radiomics, a Promising New Discipline: Example of Hepatocellular Carcinoma. Diagnostics (Basel) 2023; 13:diagnostics13071303. [PMID: 37046521 PMCID: PMC10093101 DOI: 10.3390/diagnostics13071303] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
Radiomics is a discipline that involves studying medical images through their digital data. Using “artificial intelligence” algorithms, radiomics utilizes quantitative and high-throughput analysis of an image’s textural richness to obtain relevant information for clinicians, from diagnosis assistance to therapeutic guidance. Exploitation of these data could allow for a more detailed characterization of each phenotype, for each patient, making radiomics a new biomarker of interest, highly promising in the era of precision medicine. Moreover, radiomics is non-invasive, cost-effective, and easily reproducible in time. In the field of oncology, it performs an analysis of the entire tumor, which is impossible with a single biopsy but is essential for understanding the tumor’s heterogeneity and is known to be closely related to prognosis. However, current results are sometimes less accurate than expected and often require the addition of non-radiomics data to create a performing model. To highlight the strengths and weaknesses of this new technology, we take the example of hepatocellular carcinoma and show how radiomics could facilitate its diagnosis in difficult cases, predict certain histological features, and estimate treatment response, whether medical or surgical.
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Affiliation(s)
- Thomas Lévi-Strauss
- Hepatology Unit, University Hospital of Nice, 151 Route de Saint Antoine de Ginestière, 06200 Nice, France; (T.L.-S.)
| | - Bettina Tortorici
- Department of Diagnosis and Interventional Imaging, University Hospital of Nice, 151 Route de Saint Antoine de Ginestière, 06200 Nice, France
| | - Olivier Lopez
- Department of Diagnosis and Interventional Imaging, University Hospital of Nice, 151 Route de Saint Antoine de Ginestière, 06200 Nice, France
| | - Philippe Viau
- Department of Nuclear Medicine, University Hospital of Nice, 151 Route de Saint Antoine de Ginestière, 06200 Nice, France
| | - Dann J. Ouizeman
- Hepatology Unit, University Hospital of Nice, 151 Route de Saint Antoine de Ginestière, 06200 Nice, France; (T.L.-S.)
| | | | - Xavier Adhoute
- Saint Joseph Hospital, 26 Bd de Louvain, 13008 Marseille, France
| | - Olivier Humbert
- Centre Antoine-Lacassagne, Department of Nuclear Medicine, 33 Av. de Valombrose, 06100 Nice, France
- TIRO-UMR E 4320, Université Côte d’Azur, 06000 Nice, France
| | - Patrick Chevallier
- Department of Diagnosis and Interventional Imaging, University Hospital of Nice, 151 Route de Saint Antoine de Ginestière, 06200 Nice, France
| | - Philippe Gual
- INSERM, U1065, C3M, Université Côte d’Azur, 06000 Nice, France
- Correspondence: (P.G.); (R.A.)
| | | | - Rodolphe Anty
- Hepatology Unit, University Hospital of Nice, 151 Route de Saint Antoine de Ginestière, 06200 Nice, France; (T.L.-S.)
- INSERM, U1065, C3M, Université Côte d’Azur, 06000 Nice, France
- Correspondence: (P.G.); (R.A.)
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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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Abstract
The therapeutic spectrum of hepatocellular carcinoma (HCC) in cirrhosis has expanded over the last decade and consists of surgical, interventional and systemic approaches. The tumor stage and liver function are important for the therapeutic strategy. Curation can be achieved by liver resection or transplantation. Access to transplantation is limited by organ shortage and waiting time. Locoregional therapies can be used as a bridge to transplant or for down-sizing in a neoadjuvant setting as well as palliative therapy. Advanced stages might benefit from systemic or immunotherapy. Modern multimodal therapy planning, timing and reevaluation are part of the tasks of tumor boards specialised in the liver, including the option of liver transplantation. Therapies can be used alone or in combination and according to the experience of the center. A curative strategy should always be pursued at initial presentation.
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Gundlach JP, Linecker M, Dobbermann H, Wadle F, Becker T, Braun F. Patients Benefit from Liver Transplantation for Hepatocellular Carcinoma beyond Milan Criteria without Harming the Health Care System. Cancers (Basel) 2022; 14:cancers14051136. [PMID: 35267443 PMCID: PMC8909584 DOI: 10.3390/cancers14051136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 02/04/2023] Open
Abstract
Liver transplantation (LT) is the only definitive treatment to cure hepatocellular carcinoma (HCC) in cirrhosis. Waiting-list candidates are selected by the model for end-stage liver disease (MELD). However, many indications are not sufficiently represented by labMELD. For HCC, patients are selected by Milan-criteria: Milan-in qualifies for standard exception (SE) and better organ access on the waiting list; while Milan-out patients are restricted to labMELD and might benefit from extended criteria donor (ECD)-grafts. We analyzed a cohort of 102 patients (2011−2020). Patients with labMELD (no SE, Milan-out, n = 56) and matchMELD (SE-HCC, Milan-in, n = 46) were compared. The median overall survival was not significantly different (p = 0.759). No difference was found in time on the waiting list (p = 0.881), donor risk index (p = 0.697) or median costs (p = 0.204, EUR 43,500 (EUR 17,800−185,000) for labMELD and EUR 30,300 (EUR 17,200−395,900) for matchMELD). Costs were triggered by a cut-off labMELD of 12 points. Overall, the deficit increased by EUR 580 per labMELD point. Cost drivers were re-operation (p < 0.001), infection with multiresistant germs (p = 0.020), dialysis (p = 0.017), operation time (p = 0.012) and transfusions (p < 0.001). In conclusion, this study demonstrates that LT for HCC is successful and cost-effective in low labMELD patients independent of Milan-criteria. Therefore, ECD-grafts are favorized in Milan-out HCC patients with low labMELD.
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Affiliation(s)
- Jan-Paul Gundlach
- Department of General, Visceral-, Thoracic-, Transplantation- and Pediatric Surgery, UKSH Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany; (J.-P.G.); (M.L.); (F.W.); (T.B.)
| | - Michael Linecker
- Department of General, Visceral-, Thoracic-, Transplantation- and Pediatric Surgery, UKSH Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany; (J.-P.G.); (M.L.); (F.W.); (T.B.)
| | - Henrike Dobbermann
- Department of Internal Medicine-Hepatology, UKSH Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany;
| | - Felix Wadle
- Department of General, Visceral-, Thoracic-, Transplantation- and Pediatric Surgery, UKSH Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany; (J.-P.G.); (M.L.); (F.W.); (T.B.)
| | - Thomas Becker
- Department of General, Visceral-, Thoracic-, Transplantation- and Pediatric Surgery, UKSH Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany; (J.-P.G.); (M.L.); (F.W.); (T.B.)
| | - Felix Braun
- Department of General, Visceral-, Thoracic-, Transplantation- and Pediatric Surgery, UKSH Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany; (J.-P.G.); (M.L.); (F.W.); (T.B.)
- Correspondence:
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