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. 2020 Jun;30(6):3473-3485.
doi: 10.1007/s00330-019-06640-8. Epub 2020 Feb 11.

The presence of microvascular invasion guides treatment strategy in recurrent HBV-related HCC

Shu-Ling Chen #  1 , Han Xiao #  1 , Zong-Lin Xie  2 , Jing-Xian Shen  3 , Ze-Bin Chen  4 , Yuan-Qi Wang  5 , Bin Li  6 , Zhen-Wei Peng  6   7 , Ming Kuang  1   4 , Jia-Ming Lai  8 , Sui Peng  9   10
Affiliations

The presence of microvascular invasion guides treatment strategy in recurrent HBV-related HCC

Shu-Ling Chen et al. Eur Radiol. 2020 Jun.

Abstract

Objectives: We used the status of microvascular invasion (MVI) at primary resection to help treatment selection for hepatitis B virus-positive (HBV+) recurrent hepatocellular carcinoma (rHCC) patients in Barcelona Clinic Liver Cancer (BCLC) stage B-C.

Methods: From 2009 to 2017, we enrolled 221 consecutive HBV+ rHCC patients at BCLC stage B-C who underwent re-resection (RR), radiofrequency ablation (RFA), or transarterial chemoembolization (TACE). Post recurrence survival (PRS) and overall survival (OS) were compared between RR/RFA and TACE according to MVI status. A one-to-one propensity score matching analysis was performed.

Results: For MVI(-) patients, the median PRS was 62.3 months for the RR/RFA group and 21.1 months for the TACE group (p = 0.039). The corresponding OS was 71.4 months and 26.6 months, respectively (p = 0.010). For MVI(+) patients, the median PRS in the RR/RFA group and TACE group was 14.7 months and 10.1 months (p = 0.115). The corresponding OS was 23.4 months and 16.4 months, respectively (p = 0.067). After matching, the dominance of RR/RFA over TACE remained in MVI(-) patients for both PRS (62.3 months vs 15.3 months, p = 0.019) and OS (98.1 months vs 33.4 months, p = 0.046). No significant difference was found in MVI(+) patients for either PRS (14.7 months vs 11.8 months, p = 0.593) or OS (23.4 months vs 28.1 months, p = 0.662).

Conclusions: MVI status definitely helps select treatment options in HBV+ rHCC patients. For MVI(-) patients, RR/RFA provided better survival than TACE while for MVI(+) patients, TACE shared similar survival outcomes.

Key points: • This study aimed at the determination of the optimal treatment options (ablation /resection vs TACE) in case of recurrent HBV-related HCC. • It showed that MVI status, established at primary resection of HCC, was a powerful marker for selecting the best treatment option in these patients. • In MVI(-) patients, RR/RFA achieved a better survival than TACE. In MVI(+) patients, TACE shared similar survival.

Keywords: Carcinoma, hepatocellular; Chemoembolization, therapeutic; Hepatectomy; Radiofrequency ablation; Recurrence.

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