Preoperative Diagnosis Of Microvascular Invasion In Hepatocellular Carcinoma

ObjectiveHepatocellular carcinoma (HCC) is a major health problem worldwide. Asia, especially east Asia has a higher incidence. Liver resection (LR) and liver transplantation (LT) remain the potentially curative therapy for HCC,but the recurrence is still high. Microvascular invasion (MVI) is one of the important factors influencing the recurrence of HCC. The time of postoperative recurrence of HCC is significantly shortened by MVI. MVI still lacks the gold standard for the preoperative identification. Therefore our study is investigates the relationship between MVI and the clinicopathological data of the patients with HCC, aimed to predict MVI in patients with HCC, so it can have certain guidance for preoperative diagnosis and treatment.Methods110 patients with HCC carried out surgical treatment for the first time at Drum Tower Hospital during 2012.06-2014.12 were choosed. The preoperative clinicopathological data of these patients were analyzed to predict presence of MVI. A scoring system was designed using significant risk factors. This system was applied to another series of 34 patients with HCC who underwent LR during 2015.08-2016.02, and was evaluated for validation. The clinicopathological data were divided into two groups, the positive MVI group and the negative MVI group. Measurement data was analyzed using the t test, Count data was analyzed using chi-square test or Fisher's exact test. SPSS 18.0 software (SPSS, Inc., Chicago, IL) was used for statistical analysis and P<0.05 was as statistically significant.ResultsWe find there were 110 patients who with HCC carried out surgical treatment for the first time. There were 40 patients with MVI,70 patients without MVI in the 110 patients. The age, gender, AST/ALT, HBsAg and Child-Pugh degree of the patients had no difference between the two groups. Tumor size, alpha fetoprotein (AFP) level>1000?g/L,ALT, AST, macrovascular invasion, capsule integrity, internal arteries, and morphological classification of HCC of the two groups were showing significant difference. The tumor size, alpha fetoprotein (AFP) level>1000?g/L,ALT, AST, macrovascular invasion, internal arteries of patients with MVI were higher than the control (P<0.05). The capsule integrity of patients with MVI were lower than the control (P<0.05).The internal arteries and morphological classification of HCC were independent clinical predictors for MVI after multivariate analyses. The internal arteries and Types of morphological classification were used to plot a receiver operating characteristic curve for predicting MVI. Areas under the curve of the internal arteries and types of morphological classification, were 0.654 and 0.800 respectively. Maximal sensitivity and specificity were obtained when the internal artery exists and type of morphological classification was type 3 or type 4. A scoring system was designed using these twp variables and the sensitivity and specificity of our scoring system were 62.5% and 85.7% in the 110 patients. The sensitivity and specificity of our predicting system were 70.0%% and 92.9%, respectively, in the validation test.Conclusion1. Tumor size, AFP>1000p.g/L, ALT.AST, macrovascular invasion, capsule integrity, internal arteries, and morphological classification of HCC are significant related with MVI.2. The internal arteries and morphological classification of HCC are independent risk factors for MVI.3. The new Predicting system for MVI, consisting of internal arteries and morphological classification of HCC, can provide a precise prediction of MVI of hepatocellular carcinoma.