Objective To summarize the research progress of magnetic resonance imaging (MRI) in evaluating microvascular invasion (MVI) of hepatocellular carcinoma (HCC) in order to provide information and evidence for therapy of HCC. Methods Papers published from May 1950 to May 2017, were retrieved in PubMed, OVID, CNKI database using the keywords on hepatocellular carcinoma, microvascular invasion, and magnetic resonance imaging. Sixty-seven papers were retrieved in English literatures and 13 in Chinese literatures. Criteria of paper adoption: ① the imaging method was MRI; ② the assessment content was MVI of HCC; ③ the golden standard was postoperative pathologic diagnosis. fifty-four papers were finally analyzed and reviewed. Results Currently there were various ways to evaluating the MVI of HCC using MRI, including morphology, texture analysis, diffusion-weighted imaging, dynamic-enhanced MRI, fat assessment, hepatocellular function and comprehensive evaluation. Conclusions Various methods perform differently in evaluating MVI. The use of multiparametric MRI techniques offers the potential for comprehensive assessment of MVI of HCC.
ObjectiveTo summarize research progress of molecular imaging in microvascular invasion of hepatocellular carcinoma.MethodThe literatures about the molecular imaging in recent years at home and abroad on the microvascular invasion of hepatocellular carcinoma were reviewed and analyzed.ResultsThe molecular imaging methods such as the Gd-EOB-DTPA enhanced scan, irrelevant movement within voxel diffusion weighted imaging, energy spectrum CT imaging, MR molecular probe imaging, etc. from the aspect of the microstructure multimodally studied the biological behaviors and characteristics of the disease had become the research hot topic and the development direction in the future, which played an important role in the early diagnosis and assessment of the microvascular invasion of hepatocellular carcinoma.ConclusionResearch method of molecular imaging has a prosperous prospect of clinical application in microvascular invasion of hepatocellular carcinoma.
ObjectiveTo explore the influence of 5 mm surgical margin (SM) width on the prognosis of patients with solitary hepatocellular carcinoma (HCC) and the influence of tumor size and microvascular invasion (MVI) on strategic decision of SM width.MethodsThe clinicopathologic data of patients with solitary HCC underwent the surgical resection in the West China Hospital of Sichuan University from January 2014 to September 2015 were collected. According to the inclusion and exclusion criteria of this study, the prognostic differences of the patients with SM≤5 mm and SM>5 mm were compared after the propensity score matching (PSM), and the influences of the 5 mm SM on the recurrence-free survival rate of large HCC (>5 cm) or small HCC (≤5 cm) and MVI positive or negative patients were analyzed.ResultsA total of 266 eligible patients were included, with a median overall survival of 40.01 months and a median recurrence-free survival of 37.01 months. During the follow-up period, 137 patients recurred and 75 patients died. After PSM, the basic indexes had no significant differences between the patients with SM>5 mm (n=78) and SM≤5 mm (n=78). The results of the multivariate Cox regression analysis showed that the tumor size and MVI were the important factors of the recurrence-free survival (P<0.05) and the tumor size, MVI, HBeAg, and alpha-fetoprotein (AFP) were the important factors of the overall survival (P<0.05) before the PSM; while the MVI and SM were the important factors of the recurrence-free survival (P<0.05), the gender, AFP, and MVI were the important factors of the overall survival (P<0.05) after the PSM. The recurrence-free survival rate of the patients with SM >5 mm had better than that with SM≤5 mm after the PSM, but the overall survival had no difference. In the MVI negative and large HCC subgroups, the patients with SM>5 mm showed the better recurrence-free survival rate. However, in the MVI positive and small HCC subgroups did not show any differences in the recurrence-free survival rate for the different SM widths.ConclusionsAccording to the results of this study, a wider SM (>5 mm) could improve recurrence-free survival in patients with a single tumor within BCLC stage 0/A. For patients without MVI or large HCC, SM>5 mm might be adequate. However, for patients with MVI or small HCC, the determination of an appropriate SM width needs further to be investigated.
ObjectiveTo explore the risk factors that affect the long-term prognosis of liver cancer after liver transplantation, and to evaluate the clinical value of the Chinese Medical Association’s new microvascular invasion pathological classification.MethodsThe clinical pathology and follow-up data of 112 patients with liver cancer who underwent liver transplantation from January 2015 to December 2018 were retrospectively analyzed. Prognostic risk factors were analyzed by Cox proportional hazard regression model.ResultsAll of the 112 patients were followed up. The postoperative follow-up period was 12 to 60 months [(28.3±13.5) months], and the median overall survival time was 38-month. The results of the Cox proportional hazard regression model suggested that the preoperative Child classification and microvascular invasion pathological classification were independent factors affecting the prognosis of patients (P<0.05), the higher microvascular invasion pathological classification and Child grade, the worse the prognosis.ConclusionThe Chinese Medical Association’s new microvascular invasion pathological classification can predict the prognosis of patients with liver cancer after liver transplantation and has a good predictive value.
ObjectiveTo detect the expression of FXYD domain-containing ion transport regulator 6 (FXYD6) protein in hepatocellular carcinoma tissues and the corresponding paracancerous liver tissues, and to explore the clinical significance of FXYD6 protein expression in hepatocellular carcinoma.MethodsEighty hepatocellular carcinoma tissues and the corresponding 40 paracancerous tissues were retrospectively collected in Cangzhou Central Hospital from March 2012 to January 2018, and the expression of FXYD6 protein was examined in these tissues by strept avidin-biotin complex (SABC) immunohistochemistry. We analyzed the relationship between the expression of FXYD6 protein and clinicopathological characteristics of the patients with hepatocellular carcinoma, and the relationship between the expression of the protein and early recurrence or overall survival.ResultsThe positive expression rate of FXYD6 protein was statistically higher in hepatocellular carcinoma tissues than that in the corresponding paracancerous tissues [77.5% (62/80) vs. 40.0% (16/40), P<0.001]. Its expression in hepatocellular carcinoma was not related with gender, age, histological differentiation, tumor maximum diameter, tumor number, AFP concentration in serum, and HBV or HCV infection (P>0.05), but with integrity of tumor capsule, microvascular invasion, and tumor stage (P<0.05). The positive FXYD6 protein expression group had a significantly higher recurrence rate than that of the negative FXYD6 protein expression group [53.2% (33/62) vs. 16.7% (3/18), P=0.006]. However, multivariate analysis results showed that high FXYD6 protein expression was not a risk factor for early relapse (P=0.422). The positive FXYD6 protein expression group had a significantly shorter postoperative survival than the negative FXYD6 expression group ( P=0.043). However, multivariate analysis results showed high FXYD6 protein expression was not a risk factor for overall survival (P=0.754).ConclusionsFXYD6 protein was expressed abnormally in hepatocellular carcinoma tissues, which might be involved in the carcinogenesis and the progression of hepatocellular carcinoma. It might be a poor prognostic factor for patient with hepatocellular carcinoma.
ObjectiveTo establish a model for predicting microvascular invasion (MVI) of hepatocellular carcinoma based on magnetic resonance imaging (MRI) radiomics features.MethodsThe clinical and pathological datas of 190 patients with hepatocellular carcinoma who received surgical treatment in our hospital from September 2017 to May 2020 were prospectively collected. The patients were randomly divided into training group (n=158) and test group (n=32) with a ratio of 5∶1. Gadoxetate disodium (Gd-EOB-DTPA) -enhanced MR images of arterial phase and hepatobiliary phase were used to select radiomics features through the region of interest (ROI). The ROI included the tumor lesions and the area dilating to 2 cm from the margin of the tumor. Based on a machine learning algorithm logistic, a radiomics model for predicting MVI of hepatocellular carcinoma was established in the training group, and the model was evaluated in the test group.ResultsSeven radiomics features were obtained. The area under the receiver operating characteristic curve (AUC) of the training group and the test group were 0.830 [95%CI (0.669, 0.811)] and 0.734 [95%CI (0.600, 0.936)], respectively.ConclusionThe model based on MRI radiomics features seems to be a promising approach for predicting the microvascular invasion of hepatocellular carcinoma, which is of clinical significance for the management of hepatocellular carcinoma treatment.
ObjectiveTo find out the risk factors affecting the prognoses and microvascular invasion (MVI) of patients with China Liver Cancer Staging-stageⅠ a (CNLC Ⅰ a) hepatocellular carcinoma (HCC). MethodsBased on the established inclusion and exclusion criteria, the clinicopathologic information and follow-up data of patients with CNLC Ⅰ a HCC were retrospectively collected, who underwent radical resection in the West China Hospital of Sichuan University from Jan. 2012 to Dec. 2016. The Cox proportional hazards regression was utilized to analyze the risk factors affecting the prognosis of patients with CNLC Ⅰ a HCC, and the non-conditional logistic regression was utilized to analyze the preoperative clinical indicators associating with MVI. ResultsA total of 300 patients with CNLC Ⅰ a HCC were included in this study, among which 51 (17.0%) cases accompanied with MVI. The follow-up period ranged from 2 to 104 months (median 39 months), with a recurrence time ranging from 2 to 104 months (median 52 months), and an overall survival time ranging from 3 to 104 months (median 98 months). During the follow-up period, postoperative recurrence occurred in 145 (48.3%) cases. The Cox proportional hazards regression analysis revealed that: tumor diameter >3 cm, presences of MVI and satellite nodules increased the risk of shortened recurrence time for the patients with CNLC Ⅰ a HCC (P<0.05); Factors including gamma-glutamyltranspeptidase level >60 U/L, tumor low differentiation, presences of MVI and satellite nodules were associated with shortened overall survival time for the patients with CNLC Ⅰ a HCC (P<0.05). The preoperative alpha-fetoprotein level ≥400 μg/L and tumor diameter >3 cm increased the risk of presence of MVI for the patients with CNLC Ⅰ a HCC [χ2=3.059, OR(95%CI)=2.357(1.047, 5.306), P=0.038; χ2=3.002, OR(95%CI)=2.301(1.026, 5.162), P=0.043]. ConclusionThe results of this study suggest that adopting corresponding strategies to address the risk factors affecting prognosis of patients with CNLC Ⅰ a HCC and the risk factors associated with MVI can have a significant clinical impact on improving surgical treatment outcomes for these patients.
ObjectiveTo investigate the association of lipid metabolism and other markers with microvascular invasion in hepatocellular carcinoma (HCC) and to develop a preoperative prediction model from it. MethodsData from 389 HCC patients who underwent hepatectomy at First Hospital of Lanzhou University between January 2017 and March 2023 were retrospectively analyzed. These patients were divided into training group (n=272) and validation group (n=117) with a ratio of 7 : 3. The independent risk factors of microvascular invasion (MVI) were determined by univariate and multivariate logistic regression analysis, and the MVI prediction model was established. The prediction efficiency of the model was verified by the analysis of calibration curve, receiver operating characteristic (ROC) curve and decision curve. ResultsUnivariate and multivariate logistic regression analysis showed that the risk factors independently related to MVI before operation included total cholesterol, lactate dehydrogenase, body mass index, alpha-fetoprotein, carbohydrate antigen 125, hepatitis B DNA, maximum tumor diameter and albumin-bilirubin score. MVI prediction model was established based on the above eight risk factors, and its area under ROC curve in the training group and the validation group were 0.79 [95%CI (0.74, 0.84)] and 0.75 [95%CI (0.66, 0.84)] respectively. Calibration curve analysis showed that the prediction curve fitted well with the standard curve. ROC curve analysis showed that the MVI prediction model was efficient. Decision curve analysis confirmed that the MVI prediction model had significant clinical applications. ConclusionThis study identified independent correlations between total cholesterol levels, among other things, and MVI, and successfully developed and validated novel predictive model based on these indicators that can help physicians effectively identify individuals at high risk for MVI in patients with hepatocellular carcinoma preoperatively, leading to more rational treatment choices.