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

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

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

Methods

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

Results

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

Conclusions

Our clinical scoring system, consisting of AFP, DCP, tumor size, and tumor margin in Gd-EOB-DTPA-enhanced MRI, can be valuable for predicting MVI in HCC within the Milan criteria before curative treatment.

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Acknowledgements

We thank Angela Morben, DVM, ELS, from Edanz Group (www.edanzediting.com/ac), for editing a draft of this manuscript.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Hepato-Biliary-Pancreatic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama Chuo-ku, Fukuoka, 810-8563, Japan

    Tomoki Ryu, Yuko Takami, Yoshiyuki Wada, Masaki Tateishi, Takanobu Hara, Munehiro Yoshitomi & Hideki Saitsu

  2. Department of Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan

    Tomoki Ryu, Munehiro Yoshitomi & Koji Okuda

  3. Department of Pathology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan

    Seiya Momosaki

  4. Department of Radiology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan

    Kotaro Yasumori

Authors
  1. Tomoki Ryu
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  2. Yuko Takami
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  3. Yoshiyuki Wada
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  4. Masaki Tateishi
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  6. Munehiro Yoshitomi
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  8. Kotaro Yasumori
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  9. Hideki Saitsu
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  10. Koji Okuda
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Contributions

Study conception and design: Ryu, Saitsu, and Okuda.

Acquisition of data: Ryu, Wada, Tateishi, Hara, Yoshitomi, Momosaki, and Yasumori.

Analysis and interpretation of data: Ryu, Takami, Yasumori, Momosaki, Saitsu, and Okuda.

Drafting of manuscript: Ryu.

Critical revision: Takami, Saitsu, and Okuda.

Corresponding author

Correspondence to Tomoki Ryu.

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Ryu, T., Takami, Y., Wada, Y. et al. A Clinical Scoring System for Predicting Microvascular Invasion in Patients with Hepatocellular Carcinoma Within the Milan Criteria. J Gastrointest Surg 23, 779–787 (2019). https://doi.org/10.1007/s11605-019-04134-y

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  • DOI: https://doi.org/10.1007/s11605-019-04134-y

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