A Grading System of Microvascular Invasion for Patients with Hepatocellular Carcinoma Undergoing Liver Resection with Curative Intent: A Multicenter Study

Han Wang; Jun-Jie Chen; Shu-Yi Yin; Xia Sheng; Hong-Xia Wang; Wan Yee Lau; Hui Dong; Wen-Ming Cong

doi:10.2147/JHC.S447731

A Grading System of Microvascular Invasion for Patients with Hepatocellular Carcinoma Undergoing Liver Resection with Curative Intent: A Multicenter Study

J Hepatocell Carcinoma. 2024 Jan 24:11:191-206. doi: 10.2147/JHC.S447731. eCollection 2024.

Authors

Han Wang^#¹, Jun-Jie Chen^#², Shu-Yi Yin^#³, Xia Sheng⁴, Hong-Xia Wang⁵, Wan Yee Lau⁶, Hui Dong¹, Wen-Ming Cong¹

Affiliations

¹ Department of Pathology, Shanghai Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, People's Republic of China.
² Department of Radiology, Shanghai Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, People's Republic of China.
³ Department of Pathology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, People's Republic of China.
⁴ Department of Pathology, Minhang Hospital, Fudan University, Shanghai, People's Republic of China.
⁵ Department of Pathology, Jiading District Central Hospital, Shanghai University of Medicine & Health Sciences, Shanghai, People's Republic of China.
⁶ Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China.

^# Contributed equally.

Abstract

Background: Microvascular invasion (MVI) is closely correlated with poor clinical outcomes in patients with hepatocellular carcinoma (HCC). A grading system of MVI is needed to assist in the management of HCC patient.

Methods: Multicenter data of HCC patients who underwent liver resection with curative intent was analyzed. This grading system was established by detected number and distance from tumor boundary of MVI. Survival outcomes were compared among patients in each group. This system was verified by time-receiver operating characteristic curve, time-area under the curve, calibration curve, and decision curve analyses. Cox regression analysis was performed to study the associated factors of prognosis. Logistic analysis was used to study the predictive factors of MVI.

Results: All patients were classified into 4 groups: M0: no MVI; M1: 1~5 proximal MVIs (≤1 cm from tumor boundary); M2a: >5 proximal MVIs (≤1 cm from tumor boundary); M2b: ≥1 distal MVIs (>1 cm from tumor boundary). The recurrence-free survival (RFS), overall survival (OS), and early RFS rates among all the individual groups were significantly different. Based on the number of proximal MVI (0~5 vs >5), patients in the M2b group were further divided into two subgroups which also showed different prognosis. Multiple methods showed this grading system to be significantly better than the MVI two-tiered system in prognostic evaluation. Four multivariate models for RFS, OS, early RFS, late RFS, and a predictive model of MVI were then established and were shown to satisfactorily evaluate prognosis and have a great discriminatory power, respectively.

Conclusion: This MVI grading system could precisely evaluate prognosis of HCC patients after liver resection with curative intent and it could be employed in routine pathological reports. The severity of MVI from both adjacent and distant from tumor boundary should be stated. A hypothesis about two occurrence modes of distal MVI was proposed.

Keywords: hepatectomy; hepatic resection; hepatocellular carcinoma; microvascular invasion; pathology.

Grants and funding

This work was supported by the Shanghai Science and Technology Innovation Action Plan-Medical Innovation Research Project (No. 22Y11909100).