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The characteristics of patients with macrovascular invasion in hepatocellular carcinoma: when East meets West

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Abstract

Purpose

To evaluate the prevalence and extension of macrovascular invasion (MaVI) in a large cohort of hepatocellular carcinoma (HCC) patients and analyze the association between MaVI and overall survival (OS).

Methods

From 2011 to 2018, 2540 patients with newly diagnosed HCC who were managed in our institution were enrolled in this retrospective study. Tumor invasion of the intrahepatic branches of the portal or hepatic veins was defined as peripheral MaVI. Tumor invasion of the main portal vein or inferior vena cava was defined as central MaVI.

Results

MaVI prevalence was 16.2% (n = 411). Among patients with Barcelona Clinic Liver Cancer (BCLC) stage C and Child–Pugh class A, 165 patients presented with peripheral MaVI and 89 patients with central MaVI. The median OS was 13.2 months (95% confidence interval [CI]: 11.4–15.4) in the peripheral MaVI group and 6.6 months (95% CI: 3.6–9.5) in the central MaVI group (p < 0.001). In patients with BCLC stage C and Child–Pugh class B or BCLC stage D, 68 patients presented with peripheral MaVI and 89 patients with central MaVI. The median OS was 3.6 months (95% CI: 3.1–4.2) in the peripheral MaVI group and 2.8 months (95% CI: 2.1–3.4) in the central MaVI group (p = 0.674).

Conclusion

The extension of MaVI significantly affected patient survival only in those with BCLC stage C and Child–Pugh class A. In patients with BCLC stage C and Child–Pugh class B or BCLC stage D, survival was poor irrespective of MaVI status.

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Data availability

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References

  1. Marrero JA, Kulik LM, Sirlin CB et al (2018) Diagnosis, Staging, and Management of Hepatocellular Carcinoma: 2018 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology 68:723–750. https://doi.org/10.1002/hep.29913

    Article  Google Scholar 

  2. EASL Clinical Practice Guidelines (2018) Management of hepatocellular carcinoma. J Hepatol 69:182–236. https://doi.org/10.1016/j.jhep.2018.03.019

    Article  Google Scholar 

  3. Diaz-Gonzalez A, Reig M, Bruix J (2016) Treatment of hepatocellular carcinoma. Dig Dis 34:597–602. https://doi.org/10.1159/000445275

    Article  PubMed  Google Scholar 

  4. Shi J, Lai ECH, Li N et al (2010) Surgical treatment of hepatocellular carcinoma with portal vein tumor thrombus. Ann Surg Oncol 17:2073–2080. https://doi.org/10.1245/s10434-010-0940-4

    Article  PubMed  Google Scholar 

  5. Lau WY, Sangro B, Chen PJ et al (2013) Treatment for hepatocellular carcinoma with portal vein tumor thrombosis: the emerging role for radioembolization using yttrium-90. Oncology 84:311–318. https://doi.org/10.1159/000348325

    Article  CAS  PubMed  Google Scholar 

  6. Pawlik TM, Poon RT, Abdalla EK et al (2005) Hepatectomy for hepatocellular carcinoma with major portal or hepatic vein invasion: results of a multicenter study. Surgery 137:403–410. https://doi.org/10.1016/j.surg.2004.12.012

    Article  PubMed  Google Scholar 

  7. Guarino M, Cucchetti A, Pontillo G, et al; ITA.LI.CA Group (2021). Pattern of macrovascular invasion in hepatocellular carcinoma. Eur J Clin Invest. Mar 23:e13542. https://doi.org/10.1111/eci.13542

  8. Oken M, Creech R, Tormey D et al (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 5:649–655

    Article  CAS  Google Scholar 

  9. Llovet JM, Burroughs A, Bruix J (2003) Hepatocellular carcinoma. Lancet 362:1907–1917. https://doi.org/10.1016/S0140-6736(03)14964-1

    Article  PubMed  Google Scholar 

  10. Abou-Alfa GK, Pawlik TM, Shindoh J, et al (2017) Liver. In: AJCC Cancer Staging Manual, 8th ed, Amin MB (Ed), AJCC, Chicago. 287

  11. American Joint Committee on Cancer (2010) American Joint Committee on Cancer Staging Manual, 7th ed, Edge SB, Byrd DR, Compton CC, et al (Eds), Springer, New York. 175

  12. Pugh RN, Murray-Lyon IM, Dawson JL et al (1973) Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 60:646–649. https://doi.org/10.1002/bjs.1800600817

    Article  CAS  PubMed  Google Scholar 

  13. Llovet JM, Ducreux M, Lencioni R et al (2012) EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 56:908–943. https://doi.org/10.1016/j.jhep.2011.12.001

    Article  Google Scholar 

  14. Omata M, Lesmana LA, Tateishi R et al (2010) Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma. Hepatol Int 4:439–474. https://doi.org/10.1007/s12072-010-9165-7

    Article  PubMed  PubMed Central  Google Scholar 

  15. Bruix J, Sherman M (2011) American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma: an update. Hepatology 53:1020–2. https://doi.org/10.1002/hep.24199

    Article  PubMed  Google Scholar 

  16. Yau T, Tang VY, Yao TJ et al (2014) Development of Hong Kong Liver Cancer staging system with treatment stratification for patients with hepatocellular carcinoma. Gastroenterology 146:1691–1700. https://doi.org/10.1053/j.gastro.2014.02.032

    Article  PubMed  Google Scholar 

  17. Edmonson H, Steiner P (1954) Primary carcinoma of the liver: a study of 100 cases among 48,900 necropsies. Cancer 7:462–503. https://doi.org/10.1002/1097-0142(195405)7:3%3c462::aid-cncr2820070308%3e3.0.co;2-e

  18. Everhart JE, Wright EC, Goodman ZD et al (2010) Prognostic value of Ishak fibrosis stage: findings from the hepatitis C antiviral long-term treatment against cirrhosis trial. Hepatology 51:585–594. https://doi.org/10.1002/hep.23315

    Article  PubMed  Google Scholar 

  19. Vitale A, Farinati F, Pawlik TM et al (2019) The concept of therapeutic hierarchy for patients with hepatocellular carcinoma: a multicenter cohort study. Liver Int 39:1478–1489. https://doi.org/10.1111/liv.14154

    Article  PubMed  Google Scholar 

  20. Surveillance group; Diagnosis group; Staging group; Surgery group; Local ablation group; TACE/TARE/HAI group; Target therapy/systemic therapy group; Radiotherapy group; Prevention group; Drafting group Collaborators (2018) Management consensus guideline for hepatocellular carcinoma: 2016 updated by the Taiwan Liver Cancer Association and the Gastroenterological Society of Taiwan. J Formos Med Assoc 117:381-403. https://doi.org/10.1016/j.jfma.2017.09.007

  21. Kokudo T, Hasegawa K, Matsuyama Y, Liver Cancer Study Group of Japan et al (2017) Liver resection for hepatocellular carcinoma associated with hepatic vein invasion: a Japanese nationwide survey. Hepatology 66:510–517. https://doi.org/10.1002/hep.29225

    Article  CAS  PubMed  Google Scholar 

  22. Chen ZH, Wang K, Zhang XP et al (2020) A new classification for hepatocellular carcinoma with hepatic vein tumor thrombus. Hepatobiliary Surg Nutr 9:717–728. https://doi.org/10.21037/hbsn.2019.10.07

    Article  PubMed  PubMed Central  Google Scholar 

  23. Williet N, Clavel L, Bourmaud A et al (2017) Tolerance and outcomes of sorafenib in elderly patients treated for advanced hepatocellular carcinoma. Dig Liver Dis 49:1043–1049. https://doi.org/10.1016/j.dld.2017.06.008

    Article  CAS  PubMed  Google Scholar 

  24. Serper M, Taddei TH, Mehta R, VOCAL Study Group et al (2017) Association of provider specialty and multidisciplinary care with hepatocellular carcinoma treatment and mortality. Gastroenterology 152:1954–1964. https://doi.org/10.1053/j.gastro.2017.02.040

    Article  PubMed  Google Scholar 

  25. Giannini EG, Bucci L, Garuti F, Italian Liver Cancer (ITA.LI.CA) group et al (2018) Patients with advanced hepatocellular carcinoma need a personalized management: a lesson from clinical practice. Hepatology 67:1784–1796. https://doi.org/10.1002/hep.29668

    Article  CAS  PubMed  Google Scholar 

  26. Kokudo T, Hasegawa K, Matsuyama Y, Liver Cancer Study Group of Japan et al (2016) Survival benefit of liver resection for hepatocellular carcinoma associated with portal vein invasion. J Hepatol 65:938–943. https://doi.org/10.1016/j.jhep.2016.05.044

    Article  PubMed  Google Scholar 

  27. Finn RS, Qin S, Ikeda M, IMbrave150 Investigators et al (2020) Atezolizumab plus bevacizumab in unresectable hepatocellular carcinoma. N Engl J Med 382:1894–1905. https://doi.org/10.1056/NEJMoa1915745

    Article  CAS  PubMed  Google Scholar 

  28. American College of Radiology. CT/MRI Liver imaging reporting and data system v2018 Core. https://www.acr.org/Clinical-Resources/Reporting-and-Data-Systems/LI-RADS/CT-MRI-LI-RADS-v2018. Accessed Oct 2019

  29. Tabrizian P, Jibara G, Shrager B et al (2015) Recurrence of hepatocellular cancer after resection: patterns, treatments, and prognosis. Ann Surg 261:947–955. https://doi.org/10.1097/SLA.0000000000000710

    Article  PubMed  Google Scholar 

  30. Shindoh J, Kawamura Y, Kobayashi Y et al (2021) Prognostic impact of surgical intervention after lenvatinib treatment for advanced hepatocellular carcinoma. Ann Surg Oncol. https://doi.org/10.1245/s10434-021-09974-0

    Article  PubMed  Google Scholar 

  31. Yao FY, Mehta N, Flemming J et al (2015) Downstaging of hepatocellular cancer before liver transplant: long term outcome compared to tumors within Milan criteria. Hepatology 61:1968–1977

    Article  Google Scholar 

Download references

Acknowledgements

The authors thank the Cancer Center, Kaohsiung Chang Gung Memorial Hospital, for the provision of HCC registry data. The authors thank Chih-Yun Lin and Nien-Tzu Hsu and the Biostatistics Center, Kaohsiung Chang Gung Memorial Hospital, for statistical work.

Funding

This study was supported by a grant CMRPG8J1281 from the Chang Gung Memorial Hospital-Kaohsiung Medical Center, Taiwan.

Author information

Author notes

  1. Yi-Hao Yen, Wei-Feng Li, and Chih-Chi Wang are contributed equally to this work.

Authors and Affiliations

  1. Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Kaohsiung, Taiwan

    Yi-Hao Yen, Kwong-Ming Kee, Jing-Houng Wang, Sheng-Nan Lu & Chao-Hung Hung

  2. Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, 123 Ta Pei Road, Kaohsiung, Taiwan

    Wei-Feng Li & Chih-Chi Wang

  3. Liver Transplantation Center, Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan

    Yu-Fan Cheng

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  1. Yi-Hao Yen
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Corresponding authors

Correspondence to Yi-Hao Yen or Chih-Chi Wang.

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The Institutional Review Board of Kaohsiung Chang Gung Memorial Hospital approved this study (reference number: 202000398B0) and waived the need for informed consent.

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Supplementary Information

Below is the link to the electronic supplementary material.

423_2021_2370_MOESM1_ESM.jpg

Supplementary file1 A 59-year-old man with HBV-related HCC. CT showed a 17-cm HCC over the right liver and tumor thrombus inside the IVC (arrow). (JPG 63 KB)

423_2021_2370_MOESM2_ESM.jpg

Supplementary file2 A 65-year-old man with type 2 diabetes. HBsAg and anti-HCV were both negative. Coronal view of CT showing an HCC in S7–8 (10 cm) with right hepatic vein tumor thrombosis (arrow). (JPG 77 KB)

423_2021_2370_MOESM3_ESM.jpg

Supplementary file3 A 57-year-old man with HCV-related HCC. CT showed ill-defined infiltrating HCC in the right liver lobe, 12.9 cm in size, with tumor thrombosis in the right portal vein (Arrow). (JPG 54 KB)

423_2021_2370_MOESM4_ESM.jpg

Supplementary file4 A 57-year-old man with HCV-related HCC. CT showed ill-defined infiltrating HCC in the right liver lobe, 12.9 cm in size, with tumor thrombosis in the main portal vein (arrow). (JPG 54 KB)

423_2021_2370_MOESM5_ESM.pdf

Supplementary file5 A flow chart of the patients with MaVI and applied treatments among patients with BCLC Stage C and D. (PDF 73 KB)

Supplementary File6

(PNG 9755 KB)

423_2021_2370_MOESM6_ESM.tif

High Resolution Image Overall survival of all patients according to the presence of only HVTT or only PVTT. (TIF 200 KB)

Supplementary File7

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423_2021_2370_MOESM7_ESM.tif

High Resolution Image Overall survival of patients with BCLC Stage C and Child–Pugh Class A according to the presence of only HVTT or only PVTT. (TIF 196 KB)

Supplementary File8

(PNG 9755 KB)

423_2021_2370_MOESM8_ESM.tif

High Resolution Image Overall survival of patients with BCLC Stage C and Child–Pugh Class B or BCLC Stage D according to the presence of only HVTT or only PVTT. (TIF 190 KB)

Supplementary File9

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High Resolution Image Overall survival for patients according to tumor size (TIF 143 KB)

Supplementary File10

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High Resolution Image Overall survival for patients according to AFP level (TIF 142 KB)

Supplementary File11

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High Resolution Image Overall survival for patients according to tumor differentiation (TIF 147 KB)

Supplementary File12

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High Resolution Image Overall survival for patients according to tumor number determined by pathology examination (TIF 150 KB)

Supplementary File13

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High Resolution Image Overall survival for patients according to cirrhosis status (TIF 152 KB)

423_2021_2370_MOESM14_ESM.docx

Supplementary file14 Comparison of the clinicopathologic features between patients undergoing LR with the pathology-confirmed absence of MaVI and those with pathology-confirmed peripheral MaVI (DOCX 20 KB)

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Yen, YH., Li, WF., Kee, KM. et al. The characteristics of patients with macrovascular invasion in hepatocellular carcinoma: when East meets West. Langenbecks Arch Surg 407, 225–234 (2022). https://doi.org/10.1007/s00423-021-02370-y

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