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Wang Q, Zhou Y, Yang H, Zhang J, Zeng X, Tan Y. MRI-based clinical-radiomics nomogram model for predicting microvascular invasion in hepatocellular carcinoma. Med Phys 2024. [PMID: 38642400 DOI: 10.1002/mp.17087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/12/2024] [Accepted: 04/02/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND Preoperative microvascular invasion (MVI) of liver cancer is an effective method to reduce the recurrence rate of liver cancer. Hepatectomy with extended resection and additional adjuvant or targeted therapy can significantly improve the survival rate of MVI+ patients by eradicating micrometastasis. Preoperative prediction of MVI status is of great clinical significance for surgical decision-making and the selection of other adjuvant therapy strategies to improve the prognosis of patients. PURPOSE Established a radiomics machine learning model based on multimodal MRI and clinical data, and analyzed the preoperative prediction value of this model for microvascular invasion (MVI) of hepatocellular carcinoma (HCC). METHOD The preoperative liver MRI data and clinical information of 130 HCC patients who were pathologically confirmed to be pathologically confirmed were retrospectively studied. These patients were divided into MVI-positive group (MVI+) and MVI-negative group (MVI-) based on postoperative pathology. After a series of dimensionality reduction analysis, six radiomic features were finally selected. Then, linear support vector machine (linear SVM), support vector machine with rbf kernel function (rbf-SVM), logistic regression (LR), Random forest (RF) and XGBoost (XGB) algorithms were used to establish the MVI prediction model for preoperative HCC patients. Then, rbf-SVM with the best predictive performance was selected to construct the radiomics score (R-score). Finally, we combined R-score and clinical-pathology-image independent predictors to establish a combined nomogram model and corresponding individual models. The predictive performance of individual models and combined nomogram was evaluated and compared by receiver operating characteristic curve (ROC). RESULT Alpha-fetoprotein concentration, peritumor enhancement, maximum tumor diameter, smooth tumor margins, tumor growth pattern, presence of intratumor hemorrhage, and RVI were independent predictors of MVI. Compared with individual models, the final combined nomogram model (AUC: 0.968, 95% CI: 0.920-1.000) constructed by radiometry score (R-score) combined with clinicopathological parameters and apparent imaging features showed the optimal predictive performance. CONCLUSION This multi-parameter combined nomogram model had a good performance in predicting MVI of HCC, and had certain auxiliary value for the formulation of surgical plan and evaluation of prognosis.
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Affiliation(s)
- Qinghua Wang
- Department of Radiology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- Clinical Research Center For Medical Imaging In Jiangxi Province, Nanchang, China
| | - Yongjie Zhou
- Department of Radiology, Jiangxi Cancer Hospital, Nanchang, China
| | - Hongan Yang
- Department of Radiology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- Clinical Research Center For Medical Imaging In Jiangxi Province, Nanchang, China
| | - Jingrun Zhang
- Department of Radiology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- Clinical Research Center For Medical Imaging In Jiangxi Province, Nanchang, China
| | - Xianjun Zeng
- Department of Radiology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- Clinical Research Center For Medical Imaging In Jiangxi Province, Nanchang, China
| | - Yongming Tan
- Department of Radiology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- Clinical Research Center For Medical Imaging In Jiangxi Province, Nanchang, China
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Wen Y, Lu L, Mei J, Ling Y, Guan R, Lin W, Wei W, Guo R. Hepatic Arterial Infusion Chemotherapy vs Transcatheter Arterial Chemoembolization as Adjuvant Therapy Following Surgery for MVI-Positive Hepatocellular Carcinoma: A Multicenter Propensity Score Matching Analysis. J Hepatocell Carcinoma 2024; 11:665-678. [PMID: 38596593 PMCID: PMC11001557 DOI: 10.2147/jhc.s453250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/17/2024] [Indexed: 04/11/2024] Open
Abstract
Background Microvascular invasion (MVI) is a significant pathological feature in hepatocellular carcinoma (HCC), adjuvant hepatic arterial infusion chemotherapy (a-HAIC) and adjuvant transcatheter arterial chemoembolization (a-TACE), are commonly used for HCC patients with MVI. This study aims to evaluate the efficacies of two adjuvant therapies after surgical treatment for HCC, compare them, and identify the significant factors. Methods Clinical data from two randomized controlled trials involving HCC patients with MVI after surgical treatment were retrospectively reviewed. Propensity score matching (PSM) analysis was performed to balance baseline differences between patients who received a-HAIC or a-TACE, and control groups who underwent hepatectomy alone. Disease-free survival (DFS) and overall survival (OS) rates were compared. Results In total of 549 patients were collected from two randomized controlled trials. Using the PSM and Kaplan-Meier method, the median DFS of the a-HAIC, a-TACE, and control groups was 63.2, 21.7, and 11.2 months (P<0.05). The a-HAIC group show significantly better 1-, 3-, and 5-year OS rates compared to the a-TACE and control groups (96.3%, 80.0%, 72.8% vs 84.4%, 57.0%, 29.8% vs 84.5%, 62.8%, 53.4%, P<0.05). But the OS rates of a-TACE and control groups showed no significant difference (P=0.279). Multivariate analysis identified a-HAIC (HR=0.449, P=0.000) and a-TACE (HR=0.633, P=0.007) as independent protective factors. For OS, a-HAIC (HR=0.388, P=0.003) was identified as an independent protective factor, too. Conclusion Compared to a-TACE and the control group, a-HAIC demonstrated greater benefits in preventing tumor recurrence and improving survival in HCC patients with MVI.
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Affiliation(s)
- Yuhua Wen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People’s Republic of China
- Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People’s Republic of China
| | - Lianghe Lu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People’s Republic of China
- Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People’s Republic of China
| | - Jie Mei
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People’s Republic of China
- Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People’s Republic of China
| | - Yihong Ling
- Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People’s Republic of China
- Department of Pathology of Sun Yat-sen University Cancer Center, Guangzhou, 510060, People’s Republic of China
| | - Renguo Guan
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People’s Republic of China
- Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People’s Republic of China
| | - Wenping Lin
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People’s Republic of China
- Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People’s Republic of China
| | - Wei Wei
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People’s Republic of China
- Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People’s Republic of China
| | - Rongping Guo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People’s Republic of China
- Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People’s Republic of China
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Zheng L, Wang Y, Liu Z, Wang Z, Tao C, Wu A, Li H, Xiao T, Li Z, Rong W. Identification of molecular characteristics of hepatocellular carcinoma with microvascular invasion based on deep targeted sequencing. Cancer Med 2024; 13:e7043. [PMID: 38572921 PMCID: PMC10993708 DOI: 10.1002/cam4.7043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/29/2024] [Accepted: 02/13/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND As an indicator of tumor invasiveness, microvascular invasion (MVI) is a crucial risk factor for postoperative relapse, metastasis, and unfavorable prognosis in hepatocellular carcinoma (HCC). Nevertheless, the genetic mechanisms underlying MVI, particularly for Chinese patients, remain mostly uncharted. METHODS We applied deep targeted sequencing on 66 Chinese HCC samples. Focusing on the telomerase reverse transcriptase (TERT) promoter (TERTp) and TP53 co-mutation (TERTp+/TP53+) group, gene set enrichment analysis (GSEA) was used to explore the potential molecular mechanisms of the TERTp+/TP53+ group on tumor progression and metastasis. Additionally, we evaluated the tumor immune microenvironment of the TERTp+/TP53+ group in HCC using multiplex immunofluorescence (mIF) staining. RESULTS Among the 66 HCC samples, the mutated genes that mostly appeared were TERT, TP53, and CTNNB1. Of note, we found 10 cases with TERTp+/TP53+, of which nine were MVI-positive and one was MVI-negative, and there was a co-occurrence of TERTp and TP53 (p < 0.05). Survival analysis demonstrated that patients with the TERTp+/TP53+ group had lower the disease-free survival (DFS) (p = 0.028). GSEA results indicated that telomere organization, telomere maintenance, DNA replication, positive regulation of cell cycle, and negative regulation of immune response were significantly enriched in the TERTp+/TP53+ group (all adjusted p-values (p.adj) < 0.05). mIF revealed that the TERTp+/TP53+ group decreased CD8+ T cells infiltration (p = 0.25) and enhanced PDL1 expression (p = 0.55). CONCLUSIONS TERTp+/TP53+ was significantly enriched in MVI-positive patients, leading to poor prognosis for HCC patients by promoting proliferation of HCC cell and inhibiting infiltration of immune cell surrounding HCC. TERTp+/TP53+ can be utilized as a potential indicator for predicting MVI-positive patients and poor prognosis, laying a preliminary foundation for further exploration of co-mutation in HCC with MVI and clinical treatment.
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Affiliation(s)
- Linlin Zheng
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Yaru Wang
- State Key Laboratory of Molecular Oncology, Department of Etiology and Carcinogenesis, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Zhenrong Liu
- State Key Laboratory of Molecular Oncology, Department of Etiology and Carcinogenesis, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Zhihao Wang
- Department of Hepatobiliary Hernia SurgeryLiaocheng Dongcangfu People's HospitalLiaochengChina
| | - Changcheng Tao
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Anke Wu
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Haiyang Li
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Ting Xiao
- State Key Laboratory of Molecular Oncology, Department of Etiology and Carcinogenesis, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Zhuo Li
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Weiqi Rong
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
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Wang W, Wang Y, Song D, Zhou Y, Luo R, Ying S, Yang L, Sun W, Cai J, Wang X, Bao Z, Zheng J, Zeng M, Gao Q, Wang X, Zhou J, Wang M, Shao G, Rao SX, Zhu K. A Transformer-Based microvascular invasion classifier enhances prognostic stratification in HCC following radiofrequency ablation. Liver Int 2024; 44:894-906. [PMID: 38263714 DOI: 10.1111/liv.15846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 12/15/2023] [Accepted: 01/07/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND & AIMS We aimed to develop a Transformer-based deep learning (DL) network for prognostic stratification in hepatocellular carcinoma (HCC) patients undergoing RFA. METHODS A Swin Transformer DL network was trained to establish associations between magnetic resonance imaging (MRI) datasets and the ground truth of microvascular invasion (MVI) based on 696 surgical resection (SR) patients with solitary HCC ≤3 cm, and was validated in an external cohort (n = 180). The multiphase MRI-based DL risk outputs using an optimal threshold of .5 was employed as a MVI classifier for prognosis stratification in the RFA cohort (n = 180). RESULTS Over 90% of all enrolled patients exhibited hepatitis B virus infection. Liver cirrhosis was significantly more prevalent in the RFA cohort compared to the SR cohort (72.2% vs. 44.1%, p < .001). The MVI risk outputs exhibited good performance (area under the curve values = .938 and .883) for predicting MVI in the training and validation cohort, respectively. The RFA patients at high risk of MVI classified by the MVI classifier demonstrated significantly lower recurrence-free survival (RFS) and overall survival rates at 1, 3 and 5 years compared to those classified as low risk (p < .001). Multivariate cox regression modelling of a-fetoprotein > 20 ng/mL [hazard ratio (HR) = 1.53; 95% confidence interval (95% CI): 1.02-2.33, p = .047], high risk of MVI (HR = 3.76; 95% CI: 2.40-5.88, p < .001) and unfavourable tumour location (HR = 2.15; 95% CI: 1.40-3.29, p = .001) yielded a c-index of .731 (bootstrapped 95% CI: .667-.778) for evaluating RFS after RFA. Among the three risk factors, MVI was the most powerful predictor for intrahepatic distance recurrence. CONCLUSIONS The proposed MVI classifier can serve as a valuable imaging biomarker for prognostic stratification in early-stage HCC patients undergoing RFA.
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Affiliation(s)
- Wentao Wang
- Department of Radiology, Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
| | | | - Danjun Song
- Department of Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou, China
- Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China
| | - Yingting Zhou
- Department of Hepatic Oncology, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Rongkui Luo
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Siqi Ying
- Digital Medical Research Center, School of Basic Medical Sciences, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Medical Imaging Computing and Computer Assisted Intervention, Shanghai, China
| | - Li Yang
- Department of Radiology, Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Wei Sun
- Department of Radiology, Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiabin Cai
- Department of Liver Surgery, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xi Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhen Bao
- Department of Pathology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Jiaping Zheng
- Department of Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou, China
- Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China
| | - Mengsu Zeng
- Department of Radiology, Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Qiang Gao
- Department of Liver Surgery, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
- Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Xiaoying Wang
- Department of Liver Surgery, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jian Zhou
- Department of Liver Surgery, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
- Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Manning Wang
- Digital Medical Research Center, School of Basic Medical Sciences, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Medical Imaging Computing and Computer Assisted Intervention, Shanghai, China
| | - Guoliang Shao
- Department of Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou, China
- Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China
| | - Sheng-Xiang Rao
- Department of Radiology, Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Kai Zhu
- Department of Liver Surgery, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
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Wang C, Zhang T, Sun S, Ye X, Wang Y, Pan M, Shi H. Preoperative Contrast-Enhanced Ultrasound Predicts Microvascular Invasion in Hepatocellular Carcinoma as Accurately as Contrast-Enhanced MR. J Ultrasound Med 2024; 43:439-453. [PMID: 38070130 DOI: 10.1002/jum.16375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 10/16/2023] [Accepted: 11/03/2023] [Indexed: 02/08/2024]
Abstract
OBJECTIVES Both contrast-enhanced ultrasound (CEUS) and contrast-enhanced magnetic resonance (CEMR) are important imaging methods for hepatocellular carcinoma (HCC). This study aimed to establish a model using preoperative CEUS parameters to predict microvascular invasion (MVI) in HCC, and compare its predictive efficiency with that of CEMR model. METHODS A total of 93 patients with HCC (39 cases in MVI positive group and 54 cases in MVI negative group) who underwent surgery in our hospital from January 2020 to June 2021 were retrospectively analyzed. Their clinical and imaging data were collected to establish CEUS and CEMR models for predicting MVI. The predictive efficiencies of both models were compared. RESULTS By the univariate and multivariate regression analyses of patients' clinical information, preoperative CEUS static and dynamic images, we found that serrated edge and time to peak were independent predictors of MVI. The CEUS prediction model achieved a sensitivity of 92.3%, a specificity of 83.3%, and an accuracy of 84.6% (Az: 0.934). By analyzing the clinical and CEMR information, we found that tumor morphology, fast-in and fast-out, peritumoral enhancement, and capsule were independent predictors of MVI. The CEMR prediction model achieved a sensitivity of 97.4%, a specificity of 77.8%, and an accuracy of 83.2% (Az: 0.900). The combination of the two models achieved a sensitivity of 84.6%, a specificity of 87.0%, and an accuracy of 86.2% (Az: 0.884). There was no significant statistical difference in the areas under the ROC curve of the three models. CONCLUSION The CEUS model and the CEMR model have similar predictive efficiencies for MVI of HCC. CEUS is also an effective method to predict MVI before operation.
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Affiliation(s)
- Cuiwei Wang
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Teng Zhang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shuwen Sun
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xinhua Ye
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yali Wang
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Minhong Pan
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Haibin Shi
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Ouyang X, Yan Y, Zhang S, Li M, Li M, Liu Q. Microvascular invasion is associated with poor survival in patients with dual-phenotype hepatocellular carcinoma. Am J Clin Pathol 2024; 161:245-255. [PMID: 37947176 DOI: 10.1093/ajcp/aqad143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/20/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVES Microvascular invasion (MVI) has previously been reported to be related to cancer prognosis; however, its significance in patients with dual-phenotype hepatocellular carcinoma (DPHCC) remains uncharacterized. We studied the role of MVI in the survival of patients diagnosed with DPHCC in Fujian, China, which has a high incidence of HCC. METHODS Patients with DPHCC (n = 84) who had undergone surgical interventions at the 900th Hospital of the Joint Logistic Support Force between 2013 and 2019 were retrospectively analyzed using the log-rank test and Kaplan-Meier method. Univariate and multivariate Cox model analyses were also conducted to further understand the correlation between MVI and patient survival. RESULTS Our results indicated that MVI was related to poor survival. According to the univariate analysis, MVI, the number of tumor lesions, necrosis, differentiation, peripheral hepatic fibrosis, the expression of cytokeratin 19 (CK19), and serum levels of both ɑ-fetoprotein (AFP) and cancer antigen-199 showed a strong correlation with overall survival. Necrosis and serum AFP levels were strongly related to an increased risk of death, according to the multivariate analysis. Tumor size; the number of tumor lesions; differentiation; peripheral hepatic fibrosis; liver capsule invasion; and expression of CK19, vascular endothelial growth factor, CK7, and mucin 1 showed a correlation with MVI, per the outcomes of χ2 tests. CONCLUSIONS Microvascular invasion may correlate with the survival of patients with DPHCC and could potentially serve as a prognostic predictor of survival.
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Affiliation(s)
- Xiaojuan Ouyang
- Department of Pathology, 900th Hospital of the Joint Logistics Support Force, Fuzhou,China
| | - Yongqin Yan
- Department of Pathology, 900th Hospital of the Joint Logistics Support Force, Fuzhou,China
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Sijin Zhang
- Department of Pathology, 907th Hospital of the Joint Logistics Support Force, Nanping, Fuzhou, China
| | - Meidan Li
- Department of Pathology, 900th Hospital of the Joint Logistics Support Force, Fuzhou,China
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Min Li
- Department of Pathology, 900th Hospital of the Joint Logistics Support Force, Fuzhou,China
| | - Qinghong Liu
- Department of Pathology, 900th Hospital of the Joint Logistics Support Force, Fuzhou,China
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Peng Y, Yu J, Liu F, Tang L, Li B, Zhang W, Chen K, Zhang H, Wei Y, Ma X, Shi H. Accumulation of TOX high mobility group box family member 3 promotes the oncogenesis and development of hepatocellular carcinoma through the MAPK signaling pathway. MedComm (Beijing) 2024; 5:e510. [PMID: 38463397 PMCID: PMC10924639 DOI: 10.1002/mco2.510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 02/12/2024] [Accepted: 02/12/2024] [Indexed: 03/12/2024] Open
Abstract
Microvascular invasion (MVI) has been widely valued in the field of liver surgery because MVI positivity indicates poor prognosis in hepatocellular carcinoma (HCC) patients. However, the potential molecular mechanism underlying the poor prognosis of MVI-positive HCC patients is unclear. Therefore, this study focused on identifying the key genes leading to poor prognosis in patients with a high degree of malignancy of HCC by examining the molecular signaling pathways in MVI-positive HCC patients. Through RNA sequencing, TOX high mobility group box family member 3 (TOX3) was demonstrated to be significantly highly expressed in MVI-positive HCC tissues, which was associated with poor prognosis. The results of in vivo and in vitro showed that TOX3 can promote the oncogenesis and development of HCC by targeting key molecules of the MAPK and EMT signaling pathways. The IP-MS results indicated that proteasome degradation of TOX3 in HCC cells is potentially mediated by a tripartite motif containing 56 (TRIM56, an E3 ligase) in HCC cells. Inhibiting TRIM56 enhances TOX3 protein levels. Overall, our study identified TOX3 as a key gene in the MAPK and EMT signaling pathways in HCC, and its overexpression confers significant proliferation and invasiveness to tumor cells.
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Affiliation(s)
- Yufu Peng
- Division of Liver Surgery Department of General Surgery West China Hospital Sichuan University Chengdu China
- Laboratory of Integrative Medicine Clinical Research Center for Breast State Key Laboratory of Biotherapy West China Hospital Sichuan University and Collaborative Innovation Center Chengdu China
| | - Jing Yu
- Laboratory of Integrative Medicine Clinical Research Center for Breast State Key Laboratory of Biotherapy West China Hospital Sichuan University and Collaborative Innovation Center Chengdu China
| | - Fei Liu
- Division of Liver Surgery Department of General Surgery West China Hospital Sichuan University Chengdu China
| | - Leyi Tang
- Laboratory of Integrative Medicine Clinical Research Center for Breast State Key Laboratory of Biotherapy West China Hospital Sichuan University and Collaborative Innovation Center Chengdu China
| | - Bo Li
- Division of Liver Surgery Department of General Surgery West China Hospital Sichuan University Chengdu China
| | - Wei Zhang
- Department of Critical Care Medicine State Key Laboratory of Biotherapy and Cancer Center West China Hospital Sichuan University, China
| | - Kefei Chen
- Division of Liver Surgery Department of General Surgery West China Hospital Sichuan University Chengdu China
| | - Haili Zhang
- Division of Liver Surgery Department of General Surgery West China Hospital Sichuan University Chengdu China
| | - Yonggang Wei
- Division of Liver Surgery Department of General Surgery West China Hospital Sichuan University Chengdu China
| | - Xuelei Ma
- Department of Biotherapy West China Hospital and State Key Laboratory of Biotherapy Sichuan University Chengdu China
| | - Hubing Shi
- Laboratory of Integrative Medicine Clinical Research Center for Breast State Key Laboratory of Biotherapy West China Hospital Sichuan University and Collaborative Innovation Center Chengdu China
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Zhang X, Yu X, Liang W, Zhang Z, Zhang S, Xu L, Zhang H, Feng Z, Song M, Zhang J, Feng S. Deep learning-based accurate diagnosis and quantitative evaluation of microvascular invasion in hepatocellular carcinoma on whole-slide histopathology images. Cancer Med 2024; 13:e7104. [PMID: 38488408 PMCID: PMC10941532 DOI: 10.1002/cam4.7104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/13/2023] [Accepted: 03/03/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Microvascular invasion (MVI) is an independent prognostic factor that is associated with early recurrence and poor survival after resection of hepatocellular carcinoma (HCC). However, the traditional pathology approach is relatively subjective, time-consuming, and heterogeneous in the diagnosis of MVI. The aim of this study was to develop a deep-learning model that could significantly improve the efficiency and accuracy of MVI diagnosis. MATERIALS AND METHODS We collected H&E-stained slides from 753 patients with HCC at the First Affiliated Hospital of Zhejiang University. An external validation set with 358 patients was selected from The Cancer Genome Atlas database. The deep-learning model was trained by simulating the method used by pathologists to diagnose MVI. Model performance was evaluated with accuracy, precision, recall, F1 score, and the area under the receiver operating characteristic curve. RESULTS We successfully developed a MVI artificial intelligence diagnostic model (MVI-AIDM) which achieved an accuracy of 94.25% in the independent external validation set. The MVI positive detection rate of MVI-AIDM was significantly higher than the results of pathologists. Visualization results demonstrated the recognition of micro MVIs that were difficult to differentiate by the traditional pathology. Additionally, the model provided automatic quantification of the number of cancer cells and spatial information regarding MVI. CONCLUSIONS We developed a deep learning diagnostic model, which performed well and improved the efficiency and accuracy of MVI diagnosis. The model provided spatial information of MVI that was essential to accurately predict HCC recurrence after surgery.
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Affiliation(s)
- Xiuming Zhang
- Department of Pathology, The First Affiliated Hospital, College of MedicineZhejiang UniversityHangzhouP. R. China
| | - Xiaotian Yu
- Department of Computer Science and TechnologyZhejiang UniversityHangzhouP. R. China
| | - Wenjie Liang
- Department of Radiology, The First Affiliated Hospital, College of MedicineZhejiang UniversityHangzhouP. R. China
| | - Zhongliang Zhang
- School of ManagementHangzhou Dianzi UniversityHangzhouP. R. China
| | - Shengxuming Zhang
- Department of Computer Science and TechnologyZhejiang UniversityHangzhouP. R. China
| | - Linjie Xu
- Department of Pathology, The First Affiliated Hospital, College of MedicineZhejiang UniversityHangzhouP. R. China
| | - Han Zhang
- Department of Pathology, The First Affiliated Hospital, College of MedicineZhejiang UniversityHangzhouP. R. China
| | - Zunlei Feng
- Department of Computer Science and TechnologyZhejiang UniversityHangzhouP. R. China
| | - Mingli Song
- Department of Computer Science and TechnologyZhejiang UniversityHangzhouP. R. China
| | - Jing Zhang
- Department of Pathology, The First Affiliated Hospital, College of MedicineZhejiang UniversityHangzhouP. R. China
| | - Shi Feng
- Department of Pathology, The First Affiliated Hospital, College of MedicineZhejiang UniversityHangzhouP. R. China
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Wang F, Yan CY, Qin Y, Wang ZM, Liu D, He Y, Yang M, Wen L, Zhang D. Multiple Machine-Learning Fusion Model Based on Gd-EOB-DTPA-Enhanced MRI and Aminotransferase-to-Platelet Ratio and Gamma-Glutamyl Transferase-to-Platelet Ratio to Predict Microvascular Invasion in Solitary Hepatocellular Carcinoma: A Multicenter Study. J Hepatocell Carcinoma 2024; 11:427-442. [PMID: 38440051 PMCID: PMC10911084 DOI: 10.2147/jhc.s449737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/20/2024] [Indexed: 03/06/2024] Open
Abstract
Background Currently, it is still confused whether preoperative aminotransferase-to-platelet ratio (APRI) and gamma-glutamyl transferase-to-platelet ratio (GPR) can predict microvascular invasion (MVI) in solitary hepatocellular carcinoma (HCC). We aimed to develop and validate a machine-learning integration model for predicting MVI using APRI, GPR and gadoxetic acid disodium (Gd-EOB-DTPA) enhanced MRI. Methods A total of 314 patients from XinQiao Hospital of Army Medical University were divided chronologically into training set (n = 220) and internal validation set (n = 94), and recurrence-free survival was determined to follow up after surgery. Seventy-three patients from Chongqing University Three Gorges Hospital and Luzhou People's Hospital served as external validation set. Overall, 387 patients with solitary HCC were analyzed as whole dataset set. Least absolute shrinkage and selection operator, tenfold cross-validation and multivariate logistic regression were used to gradually filter features. Six machine-learning models and an ensemble of the all models (ENS) were built. The area under the receiver operating characteristic curve (AUC) and decision curve analysis were used to evaluate model's performance. Results APRI, GPR, HBPratio3 ([liver SI‒tumor SI]/liver SI), PLT, peritumoral enhancement, non-smooth margin and peritumoral hypointensity were independent risk factors for MVI. Six machine-learning models showed good performance for predicting MVI in training set (AUCs range, 0.793-0.875), internal validation set (0.715-0.832), external validation set (0.636-0.746) and whole dataset set (0.756-0.850). The ENS achieved the highest AUCs (0.879 vs 0.858 vs 0.839 vs 0.851) in four cohorts with excellent calibration and more net benefit. Subgroup analysis indicated that ENS obtained excellent AUCs (0.900 vs 0.809 vs 0.865 vs 0.908) in HCC >5cm, ≤5cm, ≤3cm and ≤2cm cohorts. Kaplan‒Meier survival curves indicated that ENS achieved excellent stratification for MVI status. Conclusion The APRI and GPR may be new potential biomarkers for predicting MVI of HCC. The ENS achieved optimal performance for predicting MVI in different sizes HCC and may aid in the individualized selection of surgical procedures.
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Affiliation(s)
- Fei Wang
- Department of Radiology, XinQiao Hospital of Army Medical University, Chongqing, 400037, People’s Republic of China
- Department of Medical Imaging, Luzhou People’s Hospital, Luzhou, 646000, People’s Republic of China
| | - Chun Yue Yan
- Department of Emergency Medicine, Luzhou People’s Hospital, Luzhou, 646000, People’s Republic of China
| | - Yuan Qin
- Department of Radiology, Chongqing University Three Gorges Hospital, Chongqing, 404031, People’s Republic of China
| | - Zheng Ming Wang
- Department of Radiology, XinQiao Hospital of Army Medical University, Chongqing, 400037, People’s Republic of China
| | - Dan Liu
- Department of Radiology, XinQiao Hospital of Army Medical University, Chongqing, 400037, People’s Republic of China
| | - Ying He
- Department of Radiology, XinQiao Hospital of Army Medical University, Chongqing, 400037, People’s Republic of China
| | - Ming Yang
- Department of Medical Imaging, Luzhou People’s Hospital, Luzhou, 646000, People’s Republic of China
| | - Li Wen
- Department of Radiology, XinQiao Hospital of Army Medical University, Chongqing, 400037, People’s Republic of China
| | - Dong Zhang
- Department of Radiology, XinQiao Hospital of Army Medical University, Chongqing, 400037, People’s Republic of China
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钟 伟, 梁 芳, 杨 蕊, 甄 鑫. [Prediction of microvascular invasion in hepatocellular carcinoma based on multi-phase dynamic enhanced CT radiomics feature and multi-classifier hierarchical fusion model]. Nan Fang Yi Ke Da Xue Xue Bao 2024; 44:260-269. [PMID: 38501411 PMCID: PMC10954521 DOI: 10.12122/j.issn.1673-4254.2024.02.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Indexed: 03/20/2024]
Abstract
OBJECTIVE To predict microvascular invasion (MVI) in hepatocellular carcinoma (HCC) using a model based on multiphase dynamic-enhanced CT (DCE-CT) radiomics feature and hierarchical fusion of multiple classifiers. METHODS We retrospectively collected preoperative DCE-CT images from 111 patients with pathologically confirmed HCC in Guangzhou First People's Hospital between January, 2016 and April, 2020. The volume of interest was outlined in the early arterial phase, late arterial phase, portal venous phase and equilibrium phase, and radiomics features of these 4 phases were extracted. Seven classifiers based on different algorithms were trained using the filtered feature subsets to obtain multiple base classifiers under each phase. According to the hierarchical fusion strategy, a multi-criteria decision-making-based weight assignment algorithm was used for fusing each base classifier under the same phase with the model after extracting the phase information to obtain the prediction model. The proposed model was evaluated using a 5-fold cross-validation and assessed for area under the ROC curve (AUC), accuracy, sensitivity, and specificity. The prediction model was also compared with the fusion models using a single phase or multiple phases, models based on a single phase with a single classifier, models with different base classifier diversities, and 8 classifier models based on other ensemble methods. RESULTS The experimental results showed that the performance of the proposed model for predicting HCCMVI was optimal after incorporating the 4 phases and 7 classifiers, with AUC, accuracy, sensitivity, and specificity of 0.828, 0.766, 0.877, and 0.648, respectively. Comparative experiments showed that this prediction model outperformed the models based on a single phase with a single classifier and other ensemble models. CONCLUSION The proposed prediction model is effective for predicting MVI in HCC with superior performance to other models.
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Affiliation(s)
- 伟雄 钟
- 南方医科大学生物医学工程学院,广东 广州 510515School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China
| | - 芳蓉 梁
- 华南理工大学医学院,广东 广州 510006School of Medicine, South China University of Technology, Guangzhou 510006, China
| | - 蕊梦 杨
- 华南理工大学附属第二医院(广州市第一人民医院)放射科,广东 广州 510180Department of Radiology, Second Affiliated Hospital of South China University of Technology (Guangzhou First People's Hospital), Guangzhou 510180, China
- 华南理工大学医学院,广东 广州 510006School of Medicine, South China University of Technology, Guangzhou 510006, China
| | - 鑫 甄
- 南方医科大学生物医学工程学院,广东 广州 510515School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China
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Hong S, Zhang J, Liu S, Jin Q, Li J, Xia A, Xu J. Protein profiles reveal MSH6/MSH2 as a potential biomarker for hepatocellular carcinoma with microvascular invasion. Hepatol Res 2024; 54:189-200. [PMID: 37776019 DOI: 10.1111/hepr.13971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/23/2023] [Accepted: 09/26/2023] [Indexed: 10/01/2023]
Abstract
AIM Microvascular invasion (MVI) is an independent risk factor for postoperative recurrence and metastasis in hepatocellular carcinoma (HCC). However, the specific protein expression profiles that differentiate HCC with MVI from those without MVI remain unclear. METHODS The profiles of proteins in early-stage HCC tissues and normal liver tissues were characterized by quantitative proteomics techniques. Immunohistochemical (IHC) staining was undertaken on tissue microarrays from 80 HCC patients to assess the expression of MSH2 and MSH6. Cell counting, colony formation, migration, and invasion assays were carried out in vitro. RESULTS We identified 5164 proteins in both HCC tissues and adjacent normal liver tissues. Compared to HCC without MVI, 148 upregulated proteins and 97 downregulated proteins were found in HCC with MVI. Particularly noteworthy was the remarkable upregulation of MSH6/MSH2 among these dysregulated proteins in HCC with MVI. Further validation through bioinformatics prediction and IHC confirmed the elevated expression of MSH6/MSH2, which correlated with aggressive disease characteristics and poor prognosis. Receiver operating characteristic curve analyses revealed a substantial area under the curve of 0.761 (specificity 71.79%, sensitivity 73.17%) for the combined use of MSH6/MSH2. Knockdown of MSH6/MSH2 significantly inhibited HCC cell proliferation and invasion in vitro. CONCLUSIONS Our study establishes MSH6 or MSH2 as an oncogene that is prominently overexpressed during HCC progression, which provides new targets for HCC with MVI.
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Affiliation(s)
- Shengqian Hong
- Department of Hepatobiliary Surgery, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huai'an, China
| | - Jialing Zhang
- Department of Hepatobiliary Surgery, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huai'an, China
| | - Shiqi Liu
- Department of Hepatobiliary Surgery, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huai'an, China
| | - Quan Jin
- Department of Hepatobiliary Surgery, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huai'an, China
| | - Jingqi Li
- Department of Pathology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huai'an, China
| | - Anliang Xia
- Department of Hepatobiliary Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - JianBo Xu
- Department of Hepatobiliary Surgery, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huai'an, China
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Yang J, Qian J, Wu Z, Zhang W, Yin Z, Shen W, He K, He Y, Liu L. Exploring the factors affecting the occurrence of postoperative MVI and the prognosis of hepatocellular carcinoma patients treated with hepatectomy: A multicenter retrospective study. Cancer Med 2024; 13:e6933. [PMID: 38284881 PMCID: PMC10905528 DOI: 10.1002/cam4.6933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 12/27/2023] [Accepted: 01/02/2024] [Indexed: 01/30/2024] Open
Abstract
OBJECTIVE To investigate the influencing factors affecting the occurrence of microvascular invasion (MVI) and the prognosis of hepatocellular carcinoma (HCC) patients treated with hepatectomy, and to explore how MVI affects prognosis in subgroups with different prognostic factors. METHODS Clinical data of a total of 1633 patients treated surgically for HCC in four treatment centers were included, including 754 patients with MVI. By using the Cox risk regression model and the Mann-Whitney U-test, the common independent influences on prognosis and MVI were made clear. The incidence of MVI in various subgroups was then examined, as well as the relationship between MVI in various subgroups and prognosis. RESULTS The Cox risk regression model showed that MVI, Child-Pugh classification, alpha-fetoprotein (AFP), hepatocirrhosis, tumor diameter, lymphocyte-to-monocyte ratio (LMR), and, Barcelona clinic liver cancer (BCLC) grade were independent determinants of overall survival (OS), and MVI, AFP, hepatocirrhosis, tumor diameter, and LMR were influencing determinants for disease-free survival (DFS). The receiver operating characteristic (ROC) curve showed that MVI was most closely associated with patient prognosis compared to other prognostic factors. AFP, hepatocirrhosis, tumor diameter, and LMR were discovered to be common influences on the prognosis of patients with HCC and MVI when combined with the results of the intergroup comparison of MVI. After grouping, it was showed that patients with hepatocirrhosis, positive AFP (AFP ≥ 20 ng/mL), tumor diameter >50 mm, and LMR ≤3.4 had a significantly higher incidence of MVI than patients in other subgroups, and all four subgroups of MVI-positive patients had higher rates of early recurrence and mortality (p < 0.05). CONCLUSIONS MVI was found to be substantially linked with four subgroups of HCC patients with hepatocirrhosis, positive AFP, tumor diameter >50 mm, and LMR ≤3.4, and the prognosis of MVI-positive patients in all four subgroups tended to be worse.
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Affiliation(s)
- Jilin Yang
- The Second Clinical Medical College, Jinan University, ShenzhenShenzhenChina
| | - Junlin Qian
- Department of Hepatobiliary SurgeryZhongshan People's Hospital (Zhongshan Hospital Affiliated to Sun Yat‐sen University)ZhongshanChina
| | - Zhao Wu
- Department of General SurgeryThe Second Clinical Medical College of Nanchang University, The Second Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Wenjian Zhang
- Division of Hepatobiliary and Pancreas Surgery, Department of General SurgeryThe Second Clinical Medical College, The First Affiliated Hospital, Shenzhen People's Hospital, Jinan University, Southern University of Science and TechnologyShenzhenChina
| | - Zexin Yin
- Division of Hepatobiliary and Pancreas Surgery, Department of General SurgeryThe Second Clinical Medical College, The First Affiliated Hospital, Shenzhen People's Hospital, Jinan University, Southern University of Science and TechnologyShenzhenChina
| | - Wei Shen
- Department of General SurgeryThe Second Clinical Medical College of Nanchang University, The Second Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Kun He
- Department of Hepatobiliary SurgeryZhongshan People's Hospital (Zhongshan Hospital Affiliated to Sun Yat‐sen University)ZhongshanChina
| | - Yongzhu He
- Division of Hepatobiliary and Pancreas Surgery, Department of General SurgeryThe First Clinical Medical College of Nanchang University, The First Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Liping Liu
- The Second Clinical Medical College, Jinan University, ShenzhenShenzhenChina
- Division of Hepatobiliary and Pancreas Surgery, Department of General SurgeryThe Second Clinical Medical College, The First Affiliated Hospital, Shenzhen People's Hospital, Jinan University, Southern University of Science and TechnologyShenzhenChina
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Umar Garzali I, Carr BI, İnce V, Işık B, Nur Akatlı A, Yılmaz S. Microvascular Invasion in Hepatocellular Carcinoma: Some Puzzling Facets. Turk J Gastroenterol 2024; 35:143-149. [PMID: 38454246 PMCID: PMC10895888 DOI: 10.5152/tjg.2024.22769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 03/27/2023] [Indexed: 03/09/2024]
Abstract
BACKGROUND/AIMS Hepatocellular carcinoma is the main type of primary liver cancer. Macroscopic vascular invasion is usually identified during imaging, whereas microvascular invasion is usually determined by histopathological evaluation. We aim to identify the association between microvascular invasion and other markers of tumor aggressiveness and to identify the role of microvascular invasion in the prognosis of patients who were treated by liver transplantation for hepatocellular carcinoma. MATERIALS AND METHODS This is a single-center retrospective analysis of prospectively collected data. Patients who received liver transplantation for hepatocellular carcinoma were included in the study. Data were collected regarding sociodemographic variables, criteria of selection for liver transplantation, pretransplant alpha-fetoprotein, presence or absence of microvascular invasion, presence or absence of recurrence, overall survival, and disease-free survival. Data were analyzed using Statistical Package for the Social Sciences. RESULTS Sociodemographic laboratory values and radiologic tumor characteristics were found to be similar in patients with or without microvascular invasion. Our study revealed that microvascular invasion is associated with increased recurrence, decreased diseasedfree survival, and decreased overall survival, only for patients with hepatocellular carcinoma beyond Milan criteria at the time of liver transplantation. CONCLUSION For patients beyond Milan criteria, but not within Milan criteria, microvascular invasion plays a significant role in predicting recurrence and shorter survival after liver transplantation.
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Affiliation(s)
- Ibrahim Umar Garzali
- Liver Transplant Institute, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Brian I. Carr
- Liver Transplant Institute, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Volkan İnce
- Liver Transplant Institute, İnönü University Faculty of Medicine, Malatya, Turkey
- Department of Surgery, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Burak Işık
- Liver Transplant Institute, İnönü University Faculty of Medicine, Malatya, Turkey
- Department of Surgery, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Ayşe Nur Akatlı
- Department of Pathology, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Sezai Yılmaz
- Liver Transplant Institute, İnönü University Faculty of Medicine, Malatya, Turkey
- Department of Surgery, İnönü University Faculty of Medicine, Malatya, Turkey
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Yu Z, Liu Y, Dai X, Cui E, Cui J, Ma C. Enhancing preoperative diagnosis of microvascular invasion in hepatocellular carcinoma: domain-adaptation fusion of multi-phase CT images. Front Oncol 2024; 14:1332188. [PMID: 38333689 PMCID: PMC10851167 DOI: 10.3389/fonc.2024.1332188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/09/2024] [Indexed: 02/10/2024] Open
Abstract
Objectives In patients with hepatocellular carcinoma (HCC), accurately predicting the preoperative microvascular invasion (MVI) status is crucial for improving survival rates. This study proposes a multi-modal domain-adaptive fusion model based on deep learning methods to predict the preoperative MVI status in HCC. Materials and methods From January 2008 to May 2022, we collected 163 cases of HCC from our institution and 42 cases from another medical facility, with each case including Computed Tomography (CT) images from the pre-contrast phase (PCP), arterial phase (AP), and portal venous phase (PVP). We divided our institution's dataset (n=163) into training (n=119) and test sets (n=44) in an approximate 7:3 ratio. Additionally, we included cases from another institution (n=42) as an external validation set (test1 set). We constructed three single-modality models, a simple concatenated multi-modal model, two current state-of-the-art image fusion model and a multi-modal domain-adaptive fusion model (M-DAFM) based on deep learning methods. We evaluated and analyzed the performance of these constructed models in predicting preoperative MVI using the area under the receiver operating characteristic curve (AUC), decision curve analysis (DCA), and net reclassification improvement (NRI) methods. Results In comparison with all models, M-DAFM achieved the highest AUC values across the three datasets (0.8013 for the training set, 0.7839 for the test set, and 0.7454 for the test1 set). Notably, in the test set, M-DAFM's Decision Curve Analysis (DCA) curves consistently demonstrated favorable or optimal net benefits within the 0-0.65 threshold probability range. Additionally, the Net Reclassification Improvement (NRI) values between M-DAFM and the three single-modal models, as well as the simple concatenation model, were all greater than 0 (all p < 0.05). Similarly, the NRI values between M-DAFM and the two current state-of-the-art image fusion models were also greater than 0. These findings collectively indicate that M-DAFM effectively integrates valuable information from multi-phase CT images, thereby enhancing the model's preoperative predictive performance for MVI. Conclusion The M-DAFM proposed in this study presents an innovative approach to improve the preoperative predictive performance of MVI.
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Affiliation(s)
- Zhaole Yu
- School of Automation, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Yu Liu
- Laboratory of Artificial Intelligence of Biomedicine, Guilin University of Aerospace Technology, Guilin, Guangxi, China
| | - Xisheng Dai
- School of Automation, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Enming Cui
- Department of Radiology, Jiangmen Central Hospital, Jiangmen, Guangdong, China
| | - Jin Cui
- Department of Radiology, Jiangmen Central Hospital, Jiangmen, Guangdong, China
| | - Changyi Ma
- Department of Radiology, Jiangmen Central Hospital, Jiangmen, Guangdong, China
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Wang H, Chen JJ, Yin SY, Sheng X, Wang HX, Lau WY, Dong H, Cong WM. A Grading System of Microvascular Invasion for Patients with Hepatocellular Carcinoma Undergoing Liver Resection with Curative Intent: A Multicenter Study. J Hepatocell Carcinoma 2024; 11:191-206. [PMID: 38283692 PMCID: PMC10822140 DOI: 10.2147/jhc.s447731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/15/2024] [Indexed: 01/30/2024] Open
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.
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Affiliation(s)
- Han Wang
- Department of Pathology, Shanghai Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Jun-Jie Chen
- Department of Radiology, Shanghai Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Shu-Yi Yin
- Department of Pathology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Xia Sheng
- Department of Pathology, Minhang Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Hong-Xia Wang
- Department of Pathology, Jiading District Central Hospital, Shanghai University of Medicine & Health Sciences, Shanghai, People’s Republic of China
| | - Wan Yee Lau
- Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Hui Dong
- Department of Pathology, Shanghai Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Wen-Ming Cong
- Department of Pathology, Shanghai Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, People’s Republic of China
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Butz F, Dukaczewska A, Kunze CA, Krömer JM, Reinhard L, Jann H, Fehrenbach U, Müller-Debus CF, Skachko T, Pratschke J, Goretzki PE, Mogl MT, Dobrindt EM. Influence of Lymphatic, Microvascular and Perineural Invasion on Oncological Outcome in Patients with Neuroendocrine Tumors of the Small Intestine. Cancers (Basel) 2024; 16:305. [PMID: 38254794 PMCID: PMC10813650 DOI: 10.3390/cancers16020305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/03/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
For the histopathological work-up of resected neuroendocrine tumors of the small intestine (siNET), the determination of lymphatic (LI), microvascular (VI) and perineural (PnI) invasion is recommended. Their association with poorer prognosis has already been demonstrated in many tumor entities. However, the influence of LI, VI and PnI in siNET has not been sufficiently described yet. A retrospective analysis of all patients treated for siNET at the ENETS Center of Excellence Charité-Universitätsmedizin Berlin, from 2010 to 2020 was performed (n = 510). Patients who did not undergo primary resection or had G3 tumors were excluded. In the entire cohort (n = 161), patients with LI, VI and PnI status had more distant metastases (48.0% vs. 71.4%, p = 0.005; 47.1% vs. 84.4%, p < 0.001; 34.2% vs. 84.7%, p < 0.001) and had lower rates of curative surgery (58.0% vs. 21.0%, p < 0.001; 48.3% vs. 16.7%, p < 0.001; 68.4% vs. 14.3%, p < 0.001). Progression-free survival was significantly reduced in patients with LI, VI or PnI compared to patients without. This was also demonstrated in patients who underwent curative surgery. Lymphatic, vascular and perineural invasion were associated with disease progression and recurrence in patients with siNET, and these should therefore be included in postoperative treatment considerations.
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Affiliation(s)
- Frederike Butz
- Department of Surgery, Campus Charité Mitte|Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Agata Dukaczewska
- Department of Surgery, Campus Charité Mitte|Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Catarina Alisa Kunze
- Department of Pathology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Janina Maren Krömer
- Department of Surgery, Campus Charité Mitte|Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Lisa Reinhard
- Department of Surgery, Campus Charité Mitte|Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Henning Jann
- Department of Hepatology and Gastroenterology, Campus Charité Mitte|Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Uli Fehrenbach
- Department of Radiology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Charlotte Friederieke Müller-Debus
- Department of Surgery, Campus Charité Mitte|Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Tatiana Skachko
- Department of Surgery, Campus Charité Mitte|Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte|Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Peter E. Goretzki
- Department of Surgery, Campus Charité Mitte|Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Martina T. Mogl
- Department of Surgery, Campus Charité Mitte|Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Eva Maria Dobrindt
- Department of Surgery, Campus Charité Mitte|Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
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Xiang C, Shen X, Zeng X, Zhang Y, Ma Z, Zhang G, Song X, Huang T, Yang J. Effect of transarterial chemoembolization as postoperative adjuvant therapy for intermediate-stage hepatocellular carcinoma with microvascular invasion: a multicenter cohort study. Int J Surg 2024; 110:315-323. [PMID: 37812183 PMCID: PMC10793739 DOI: 10.1097/js9.0000000000000805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 09/18/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Intermediate-stage hepatocellular carcinoma (HCC) with microvascular invasion (MVI) is associated with high recurrence rates and poor survival outcomes after surgery. This study aimed to evaluate the efficacy of postoperative transarterial chemoembolization (TACE) on prognosis of intermediate-stage HCC patients with MVI after curative liver resection (LR). MATERIALS AND METHODS Patients who had intermediate-stage HCC with MVI and underwent curative LR between January 2013 and December 2019 at three institutions in China were identified for further analysis. Overall survival (OS) and recurrence-free survival (RFS) were compared between patients treated with and without postoperative TACE by propensity score-matching. RESULTS A total of 246 intermediate-stage HCC patients with MVI were enrolled, 137 entered into the LR group and 109 entered into the LR+TACE group. The 1-year, 3-year, and 5-year RFS rates were 42.0, 27.2, and 17.8% in LR+TACE group, and 31.8, 18.2, and 8.7% in LR group. The 1-year, 3-year, and 5-year OS rates were 81.7, 47.2, and 26.1% in the LR+TACE group, and 67.3, 35.6, and 18.5% in the LR group. Compared with LR alone, LR+TACE was associated with significantly better RFS [hazard ratio (HR), 1.443; 95% CI: 1.089-1.914; P =0.009] and OS (HR, 1.438; 95% CI: 1.049-1.972; P =0.023). No difference was observed with RFS and OS in single TACE and multiple TACE in the matched cohort. CONCLUSION Postoperative adjuvant TACE could be beneficial for intermediate-stage HCC patients with MVI.
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Affiliation(s)
| | - Xianbo Shen
- Department of Hepatobiliary Surgery, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University) Changsha
| | - Xinxin Zeng
- Department of Hepatobiliary Surgery, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University) Changsha
| | - Yuzhong Zhang
- Department of Hepatobiliary Surgery, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University) Changsha
| | - Zhongzhi Ma
- Department of Hepatobiliary Surgery, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University) Changsha
| | - Guocan Zhang
- Department of Hepatobiliary Surgery, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University) Changsha
| | - Xin Song
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Jishou University, Jishou, Hunan province
| | - Tao Huang
- Department of Minimally Invasive Intervention, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Guangzhou, Guangdong province, People’s Republic of China
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Deng L, Tang HZ, Luo YW, Feng F, Wu JY, Li Q, Qiang JW. Preoperative CT Radiomics Nomogram for Predicting Microvascular Invasion in Stage I Non-Small Cell Lung Cancer. Acad Radiol 2024; 31:46-57. [PMID: 37331866 DOI: 10.1016/j.acra.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/08/2023] [Accepted: 05/15/2023] [Indexed: 06/20/2023]
Abstract
RATIONALE AND OBJECTIVES: This study aims to develop and validate a nomogram integrating clinical-CT and radiomic features for preoperative prediction of microvascular invasion (MVI) in patients with stage I non‑small cell lung cancer (NSCLC). MATERIALS AND METHODS This retrospective study analyzed 188 cases of stage I NSCLC (63 MVI positives and 125 negatives), which were randomly assigned to training (n = 133) and validation cohorts (n = 55) at a ratio of 7:3. Preoperative non-contrast and contrast-enhanced CT (CECT) images were used to analyze computed tomography (CT) features and extract radiomics features. The student's t-test, the Mann-Whitney-U test, the Pearson correlation, the least absolute shrinkage and selection operator, and multivariable logistic analysis were used to select the significant CT and radiomics features. Multivariable logistic regression analysis was performed to build the clinical-CT, radiomics, and integrated models. The predictive performances were evaluated through the receiver operating characteristic curve and compared with the DeLong test. The integrated nomogram was analyzed regarding discrimination, calibration, and clinical significance. RESULTS The rad-score was developed with one shape and four textural features. The integrated nomogram incorporating radiomics score, spiculation, and the number of tumor-related vessels (TVN) demonstrated better predictive efficacy than the radiomics and clinical-CT models in the training cohort (area under the curve [AUC], 0.893 vs 0.853 and 0.828, and p = 0.043 and 0.027, respectively) and validation cohort (AUC, 0.887 vs 0.878 and 0.786, and p = 0.761 and 0.043, respectively). The nomogram also demonstrated good calibration and clinical usefulness. CONCLUSION The radiomics nomogram integrating the radiomics with clinical-CT features demonstrated good performance in predicting MVI status in stage I NSCLC. The nomogram may be a useful tool for physicians in improving personalized management of stage I NSCLC.
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Affiliation(s)
- Lin Deng
- Department of Radiology, Jinshan Hospital & Shanghai Medical College, Fudan University, Shanghai, China (L.D., H.Z.T., J.Y.W., J.W.Q.)
| | - Han Zhou Tang
- Department of Radiology, Jinshan Hospital & Shanghai Medical College, Fudan University, Shanghai, China (L.D., H.Z.T., J.Y.W., J.W.Q.)
| | - Ying Wei Luo
- Department of Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center/Cancer Hospital, Guangzhou, China (Y.W.L., Q.L.)
| | - Feng Feng
- Department of Radiology, Affiliated Tumor Hospital of Nantong University, Nantong, China (F.F.)
| | - Jing Yan Wu
- Department of Radiology, Jinshan Hospital & Shanghai Medical College, Fudan University, Shanghai, China (L.D., H.Z.T., J.Y.W., J.W.Q.)
| | - Qiong Li
- Department of Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center/Cancer Hospital, Guangzhou, China (Y.W.L., Q.L.)
| | - Jin Wei Qiang
- Department of Radiology, Jinshan Hospital & Shanghai Medical College, Fudan University, Shanghai, China (L.D., H.Z.T., J.Y.W., J.W.Q.).
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Wang K, Shi JH, Gao J, Sun Y, Wang Z, Shi X, Guo W, Jin Y, Zhang S. Arachidonic acid metabolism CYP450 pathway is deregulated in hepatocellular carcinoma and associated with microvascular invasion. Cell Biol Int 2024; 48:31-45. [PMID: 37655528 DOI: 10.1002/cbin.12086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/08/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023]
Abstract
Arachidonic acid metabolism plays a crucial role in the development and progression of inflammatory and metabolic liver diseases. However, its role in hepatocellular carcinoma (HCC) remains unclear. In this study, we investigated the expression of key genes involved in the arachidonic acid metabolism pathway in HCC using a combination of bioinformatics, proteomics and immunohistochemistry analyses. Through a comprehensive analysis of publicly available datasets, clinical HCC tissues, and tissue microarrays, we compared the expression of hepatic arachidonic acid metabolic genes. We observed significant downregulation of cytochrome P450 (CYP450) pathway genes at both the messenger RNA and protein levels in HCC tissues compared to normal liver tissues. Furthermore, we observed a strong correlation between the deregulation of the arachidonic acid metabolism CYP450 pathway and the pathological features and prognosis of HCC. Specifically, the expression of CYP2C8/9/18/19 was significantly correlated with pathological grade (r = -.484, p < .0001), vascular invasion (r = -.402, p < .0001), aspartate transaminase (r = -.246, p = .025), gamma-glutamyl transpeptidase (r = -.252, p = .022), alkaline phosphatase (r = -.342, p = .002), alpha-fetoprotein (r = -.311, p = .004) and carbohydrate antigen 19-9 (r = -.227, p = .047). Moreover, we discovered a significant association between CYP450 pathway activity and vascular invasion in HCC. Collectively, these data indicate that arachidonic acid CYP450 metabolic pathway deregulation is implicated in HCC progression and may be a potential predictive factor for early recurrence in patients with HCC.
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Affiliation(s)
- Kai Wang
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Diagnosis and Treatment League for Hepatopathy Henan Research Centre for Organ Transplantation, Zhengzhou, China
- Open and Key Laboratory for Hepatobiliary and Pancreatic Surgery and Digestive Organ Transplantation at Henan Universities, Zhengzhou, China
- Zhengzhou Key Laboratory for Hepatobiliary and Pancreatic Diseases and Organ Transplantation, Zhengzhou, China
| | - Ji-Hua Shi
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Diagnosis and Treatment League for Hepatopathy Henan Research Centre for Organ Transplantation, Zhengzhou, China
- Open and Key Laboratory for Hepatobiliary and Pancreatic Surgery and Digestive Organ Transplantation at Henan Universities, Zhengzhou, China
- Zhengzhou Key Laboratory for Hepatobiliary and Pancreatic Diseases and Organ Transplantation, Zhengzhou, China
| | - Jie Gao
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Diagnosis and Treatment League for Hepatopathy Henan Research Centre for Organ Transplantation, Zhengzhou, China
- Open and Key Laboratory for Hepatobiliary and Pancreatic Surgery and Digestive Organ Transplantation at Henan Universities, Zhengzhou, China
- Zhengzhou Key Laboratory for Hepatobiliary and Pancreatic Diseases and Organ Transplantation, Zhengzhou, China
| | - Yaohui Sun
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Diagnosis and Treatment League for Hepatopathy Henan Research Centre for Organ Transplantation, Zhengzhou, China
- Open and Key Laboratory for Hepatobiliary and Pancreatic Surgery and Digestive Organ Transplantation at Henan Universities, Zhengzhou, China
- Zhengzhou Key Laboratory for Hepatobiliary and Pancreatic Diseases and Organ Transplantation, Zhengzhou, China
| | - Zhihui Wang
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Diagnosis and Treatment League for Hepatopathy Henan Research Centre for Organ Transplantation, Zhengzhou, China
- Open and Key Laboratory for Hepatobiliary and Pancreatic Surgery and Digestive Organ Transplantation at Henan Universities, Zhengzhou, China
- Zhengzhou Key Laboratory for Hepatobiliary and Pancreatic Diseases and Organ Transplantation, Zhengzhou, China
| | - Xiaoyi Shi
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Diagnosis and Treatment League for Hepatopathy Henan Research Centre for Organ Transplantation, Zhengzhou, China
- Open and Key Laboratory for Hepatobiliary and Pancreatic Surgery and Digestive Organ Transplantation at Henan Universities, Zhengzhou, China
- Zhengzhou Key Laboratory for Hepatobiliary and Pancreatic Diseases and Organ Transplantation, Zhengzhou, China
| | - Wenzhi Guo
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Diagnosis and Treatment League for Hepatopathy Henan Research Centre for Organ Transplantation, Zhengzhou, China
- Open and Key Laboratory for Hepatobiliary and Pancreatic Surgery and Digestive Organ Transplantation at Henan Universities, Zhengzhou, China
- Zhengzhou Key Laboratory for Hepatobiliary and Pancreatic Diseases and Organ Transplantation, Zhengzhou, China
| | - Yang Jin
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuijun Zhang
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Diagnosis and Treatment League for Hepatopathy Henan Research Centre for Organ Transplantation, Zhengzhou, China
- Open and Key Laboratory for Hepatobiliary and Pancreatic Surgery and Digestive Organ Transplantation at Henan Universities, Zhengzhou, China
- Zhengzhou Key Laboratory for Hepatobiliary and Pancreatic Diseases and Organ Transplantation, Zhengzhou, China
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Tao C, Zhang K, Tao Z, Liu Y, Wu A, Wang L, Feng Q, Wu F, Rong W, Wu J. Clinical benefits of intraoperative radiotherapy for the recurrence of centrally located hepatocellular carcinoma with microvascular invasion. Cancer Rep (Hoboken) 2024; 7:e1928. [PMID: 37906430 PMCID: PMC10809203 DOI: 10.1002/cnr2.1928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 09/29/2023] [Accepted: 10/16/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Although the efficacy and safety of intraoperative radiotherapy (IORT) in the treatment of malignant tumours, such as breast cancer, have been documented, it remains unclear whether this treatment is effective for centrally located hepatocellular carcinoma (HCC) with microvascular invasion (MVI). AIMS This study aimed to explore the efficacy and safety of IORT in the treatment of centrally located HCC with MVI. METHODS AND RESULTS Patients with centrally located HCC, who underwent surgery between January 2016 and January 2020, were enrolled. The patient cohort was then allocated to two groups: those who underwent IORT combined with liver resection (IORT+LR); or LR alone (LR). Propensity score matching and Cox proportional hazards regression analyses were performed. The Kaplan-Meier method was used to estimate recurrence-free survival (RFS), and the log-rank test was used to determine whether RFS differed between the groups. Subgroup analysis was performed to evaluate differences in RFS and early recurrence rates in patients with different MVI grades. E-values were generated to measure the sensitivity to unmeasured confounding factors. In total, 97 patients were enrolled, 27 of whom underwent IORT+LR and 70 underwent LR alone. The 1-, 3-, and 5-year RFS rates in the IORT+LR group were 66%, 50%, and 32%, respectively, whereas those in the LR group were 54%, 37%, and 26%, respectively. After matching analysis, 23 patients were successfully matched, and RFS was found to be significantly different between the two groups (p = .04). IORT was an independent prognostic factor for RFS (hazard ratio 0.46 [95% confidence interval 0.21-0.99]). In subgroup analysis, RFS between the IORT+LR and LR groups was significantly different in patients with MVI (M1 grade) (p = .0067). The postoperative early recurrence rate was significantly reduced with IORT (p < .05). No serious complications were reported in either group following surgery. Based on E-values, the results appeared to be robust against unmeasured confounding factors. CONCLUSION IORT+LR provided safe, feasible treatment for patients with centrally located HCC with MVI, along with an improvement in prognosis and lower early recurrence rates.
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Affiliation(s)
- Changcheng Tao
- Department of Hepatobiliary SurgeryNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Kai Zhang
- Department of Interventional TherapyTianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for CancerTianjinChina
| | - Zonggui Tao
- Department of ImagingJinan City People's Hospital, Shandong First Medical UniversityJinanChina
| | - Yue Liu
- Department of Hepatobiliary SurgeryNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Anke Wu
- Department of Hepatobiliary SurgeryNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Liming Wang
- Department of Hepatobiliary SurgeryNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Qinfu Feng
- Department of Radiation OncologyNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Fan Wu
- Department of Hepatobiliary SurgeryNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Weiqi Rong
- Department of Hepatobiliary SurgeryNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Jianxiong Wu
- Department of Hepatobiliary SurgeryNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
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Zhang Y, Yang C, Qian X, Dai Y, Zeng M. Evaluate the Microvascular Invasion of Hepatocellular Carcinoma (≤5 cm) and Recurrence Free Survival with Gadoxetate Disodium-Enhanced MRI-Based Habitat Imaging. J Magn Reson Imaging 2023. [PMID: 38156807 DOI: 10.1002/jmri.29207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Tumors are heterogenous and consist of subregions, also known as tumoral habitats, each exhibiting varied biological characteristics. Each habitat corresponds to a cluster of tissue sharing similar structural, metabolic, or functional characteristics. The habitat imaging technique facilitates both the visualization and quantification of these tumoral habitats. PURPOSE To evaluate the microvascular invasion (MVI) in hepatocellular carcinoma (HCC) (≤5 cm) and assess the recurrence-free survival (RFS) using gadoxetate disodium-enhanced MRI-based habitat imaging. STUDY TYPE Retrospective. SUBJECTS 180 patients (52.9 years ± 11.7, 156 men) with HCC. FIELD STRENGTH/SEQUENCE 1.5T/contrast-enhanced T1-weighted gradient-echo sequence. ASSESSMENT The enhancement ratio of signal intensity at the arterial phase (AER) and hepatobiliary phase (HBPER) were calculated. The HCC lesions and their peritumoral tissues of 3, 5, and 7 mm were encoded into four habitats. The volume fraction of each habitat was then quantified. The diagnostic performance was assessed using the receiver operating characteristic analysis with 5-fold cross-validation. The RFS was evaluated with Kaplan-Meier curves. RESULTS Habitat 2 (with median to high AER and low HBPER) within the peritumoral tissue of 3 mm (f2 -P3 ) and tumor diameter could serve as independent risk factors for MVI and showed the statistical significance (odds ratio (OR) of f2 -P3 = 1.170, 95% CI = 1.099-1.246; OR of tumor diameter: 6.112, 95% CI = 2.162-17.280). A nomogram was developed by incorporating f2 -P3 and tumor diameter, demonstrating high diagnostic accuracy. The area under the curve from 5-fold cross-validation ranged from 0.880 to 1.000. Additionally, the nomogram model demonstrated high efficacy in risk stratification for RFS. CONCLUSION Habitat imaging of HCC and its peritumoral microenvironment has the potential for noninvasive and preoperative identification of MVI and prognostic assessment. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Yunfei Zhang
- Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chun Yang
- Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xianling Qian
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yongming Dai
- School of Biomedical Engineering, ShanghaiTech University, Shanghai, China
| | - Mengsu Zeng
- Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
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Peng YC, Xu JX, You XM, Huang YY, Ma L, Li LQ, Qi LN. Specific gut microbiome signature predicts hepatitis B virus-related hepatocellular carcinoma patients with microvascular invasion. Ann Med 2023; 55:2283160. [PMID: 38112540 PMCID: PMC10986448 DOI: 10.1080/07853890.2023.2283160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 11/08/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND We aimed to assess differences in intestinal microflora between patients with operable hepatitis B virus-related hepatocellular carcinoma (HBV-HCC) with microvascular invasion (MVI) and those without MVI. Additionally, we investigated the potential of the microbiome as a non-invasive biomarker for patients with MVI. METHODS We analyzed the preoperative gut microbiomes (GMs) of two groups, the MVI (n = 46) and non-MVI (n = 56) groups, using 16S ribosomal RNA gene sequencing data. At the operational taxonomic unit level, we employed random forest models to predict MVI risk and validated the results in independent validation cohorts [MVI group (n = 17) and non-MVI group (n = 15)]. RESULTS β diversity analysis, utilizing weighted UniFrac distances, revealed a significant difference between the MVI and non-MVI groups, as indicated by non-metric multidimensional scaling and principal coordinate analysis. We also observed a significant correlation between the characteristic intestinal microbial communities at the genus level and their main functions. Nine optimal microbial markers were identified, with an area under the curve of 79.76% between 46 MVI and 56 non-MVI samples and 79.80% in the independent verification group. CONCLUSION This pioneering analysis of the GM in patients with operable HBV-HCC with and without MVI opens new avenues for treating HBV-HCC with MVI. We successfully established a diagnostic model and independently verified microbial markers for patients with MVI. As preoperative targeted biomarkers, GM holds potential as a non-invasive tool for patients with HBV-HCC with MVI.
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Affiliation(s)
- Yu-Chong Peng
- Department of General Surgery, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Jing-Xuan Xu
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, China
- Ministry of Education, Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Nanning, China
| | - Xue-Mei You
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, China
- Ministry of Education, Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Nanning, China
| | - Yi-Yue Huang
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, China
- Ministry of Education, Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Nanning, China
| | - Liang Ma
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, China
- Ministry of Education, Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Nanning, China
| | - Le-Qun Li
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, China
- Ministry of Education, Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Nanning, China
- Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Center, Nanning, China
| | - Lu-Nan Qi
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, China
- Ministry of Education, Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Nanning, China
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Wang X, Zhao Y, Bai T, Ye J, Lu S, Wu F, Li L, Chen J. Serum immune biomarker levels combined with hepatitis B virus infection status predict early recurrence of early-stage hepatocellular carcinoma with microvascular invasion after liver resection. Acta Chir Belg 2023; 123:659-665. [PMID: 36222747 DOI: 10.1080/00015458.2022.2136051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/09/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The tumor immune response plays a vital role in cancer recurrence in patients with malignancies. We aim to clarify the risk factors for early recurrence and investigate the efficacy of blood-based biomarkers to predict the risk of early recurrence in early-stage hepatocellular carcinoma (HCC) patients with microvascular invasion (MVI) after hepatectomy. MATERIALS AND METHODS A total of 101 cases of HCC with MVI who underwent liver resection were enrolled. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors of early recurrence. We calculated the area under the receiver operating characteristic curve to evaluate the performance of the four biomarkers identified as risk factors for early recurrence. RESULTS Multiple logistic regression analysis indicated that complement (C)4, cluster of differentiation (CD)4+, immunoglobulin A (IgA), and hepatitis B virus (HBV) DNA of greater than 500 IU/mL were correlated with early recurrence of HCC. The area under the curve was greater for the combination model than for the HBV DNA, CD4+, IgA, or C4 models alone. CONCLUSION Preoperative serum CD4+, C4, IgA, and HBV DNA levels were linked with early recurrence of early-stage HCC with MVI and the combination model was of considerable predictive value for the prognosis of HCC with MVI.
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Affiliation(s)
- Xiaobo Wang
- Department of Hepatobiliary Surgery, Guangxi Medical University Affiliated Cancer Hospital, Nanning, China
| | - Yuanquan Zhao
- Department of Hepatobiliary Surgery, Guangxi Medical University Affiliated Cancer Hospital, Nanning, China
| | - Tao Bai
- Department of Hepatobiliary Surgery, Guangxi Medical University Affiliated Cancer Hospital, Nanning, China
| | - Jiazhou Ye
- Department of Hepatobiliary Surgery, Guangxi Medical University Affiliated Cancer Hospital, Nanning, China
| | - Shaolong Lu
- Department of Hepatobiliary Surgery, Guangxi Medical University Affiliated Cancer Hospital, Nanning, China
| | - Feixiang Wu
- Department of Hepatobiliary Surgery, Guangxi Medical University Affiliated Cancer Hospital, Nanning, China
| | - Lequn Li
- Department of Hepatobiliary Surgery, Guangxi Medical University Affiliated Cancer Hospital, Nanning, China
| | - Jie Chen
- Department of Hepatobiliary Surgery, Guangxi Medical University Affiliated Cancer Hospital, Nanning, China
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Liu J, Zhuang G, Bai S, Hu Z, Xia Y, Lu C, Wang J, Wang C, Liu L, Li F, Wu Y, Shen F, Wang K. The Comparison of Surgical Margins and Type of Hepatic Resection for Hepatocellular Carcinoma With Microvascular Invasion. Oncologist 2023; 28:e1043-e1051. [PMID: 37196175 PMCID: PMC10628578 DOI: 10.1093/oncolo/oyad124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/11/2023] [Indexed: 05/19/2023] Open
Abstract
OBJECTIVE The objective of this study was to investigate the impact of surgical margin and hepatic resection on prognosis and compare their importance on prognosis in patients with hepatocellular carcinoma (HCC). METHODS The clinical data of 906 patients with HCC who underwent hepatic resection in our hospital from January 2013 to January 2015 were collected retrospectively. All patients were divided into anatomical resection (AR) (n = 234) and nonanatomical resection (NAR) group (n = 672) according to type of hepatic resection. The effects of AR and NAR and wide and narrow margins on overall survival (OS) and time to recurrence (TTR) were analyzed. RESULTS In all patients, narrow margin (1.560, 1.278-1.904; 1.387, 1.174-1.639) is an independent risk factor for OS and TTR, and NAR is not. Subgroup analysis showed that narrow margins (2.307, 1.699-3.132; 1.884, 1.439-2.468), and NAR (1.481, 1.047-2.095; 1.372, 1.012-1.860) are independent risk factors for OS and TTR in patients with microvascular invasion (MVI)-positive. Further analysis showed that for patients with MVI-positive HCC, NAR with wide margins was a protective factor for OS and TTR compared to AR with narrow margins (0.618, 0.396-0.965; 0.662, 0.448-0.978). The 1, 3, and 5 years OS and TTR rate of the two group were 81%, 49%, 29% versus 89%, 64%, 49% (P = .008) and 42%, 79%, 89% versus 32%, 58%, 74% (P = .024), respectively. CONCLUSIONS For patients with MVI-positive HCC, AR and wide margins were protective factors for prognosis. However, wide margins are more important than AR on prognosis. In the clinical setting, if the wide margins and AR cannot be ensured at the same time, the wide margins should be ensured first.
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Affiliation(s)
- Jianwei Liu
- Department of Hepatic Surgery II, Third Affiliated Hospital of Naval Medical University (Eastern Hepatobiliary Surgery Hospital), Shanghai, People's Republic of China
| | - Guokun Zhuang
- Department of Hepatic Surgery II, Third Affiliated Hospital of Naval Medical University (Eastern Hepatobiliary Surgery Hospital), Shanghai, People's Republic of China
| | - Shilei Bai
- Department of Hepatic Surgery II, Third Affiliated Hospital of Naval Medical University (Eastern Hepatobiliary Surgery Hospital), Shanghai, People's Republic of China
| | - Zhiliang Hu
- Department of Hepatic Surgery II, Third Affiliated Hospital of Naval Medical University (Eastern Hepatobiliary Surgery Hospital), Shanghai, People's Republic of China
| | - Yong Xia
- Department of Hepatic Surgery IV, Third Affiliated Hospital of Naval Medical University (Eastern Hepatobiliary Surgery Hospital), Shanghai, People's Republic of China
| | - Caixia Lu
- Department of Hepatic Surgery II, Third Affiliated Hospital of Naval Medical University (Eastern Hepatobiliary Surgery Hospital), Shanghai, People's Republic of China
| | - Jie Wang
- Department of Hepatic Surgery II, Third Affiliated Hospital of Naval Medical University (Eastern Hepatobiliary Surgery Hospital), Shanghai, People's Republic of China
| | - Chunyan Wang
- Department of Hepatic Surgery II, Third Affiliated Hospital of Naval Medical University (Eastern Hepatobiliary Surgery Hospital), Shanghai, People's Republic of China
| | - Liu Liu
- Department of Hepatic Surgery II, Third Affiliated Hospital of Naval Medical University (Eastern Hepatobiliary Surgery Hospital), Shanghai, People's Republic of China
| | - Fengwei Li
- Department of Hepatic Surgery II, Third Affiliated Hospital of Naval Medical University (Eastern Hepatobiliary Surgery Hospital), Shanghai, People's Republic of China
| | - Yeye Wu
- Department of Hepatic Surgery II, Third Affiliated Hospital of Naval Medical University (Eastern Hepatobiliary Surgery Hospital), Shanghai, People's Republic of China
| | - Feng Shen
- Department of Hepatic Surgery IV, Third Affiliated Hospital of Naval Medical University (Eastern Hepatobiliary Surgery Hospital), Shanghai, People's Republic of China
- Department of Hepatic Surgery II, Third Affiliated Hospital of Naval Medical University (Eastern Hepatobiliary Surgery Hospital), Shanghai, People's Republic of China
| | - Kui Wang
- Department of Hepatic Surgery II, Third Affiliated Hospital of Naval Medical University (Eastern Hepatobiliary Surgery Hospital), Shanghai, People's Republic of China
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Sun B, Ji WD, Wang WC, Chen L, Ma JY, Tang EJ, Lin MB, Zhang XF. Circulating tumor cells participate in the formation of microvascular invasion and impact on clinical outcomes in hepatocellular carcinoma. Front Genet 2023; 14:1265866. [PMID: 38028589 PMCID: PMC10652898 DOI: 10.3389/fgene.2023.1265866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is a common malignant tumor worldwide. Although the treatment strategies have been improved in recent years, the long-term prognosis of HCC is far from satisfactory mainly due to high postoperative recurrence and metastasis rate. Vascular tumor thrombus, including microvascular invasion (MVI) and portal vein tumor thrombus (PVTT), affects the outcome of hepatectomy and liver transplantation. If vascular invasion could be found preoperatively, especially the risk of MVI, more reasonable surgical selection will be chosen to reduce the risk of postoperative recurrence and metastasis. However, there is a lack of reliable prediction methods, and the formation mechanism of MVI/PVTT is still unclear. At present, there is no study to explore the possibility of tumor thrombus formation from a single circulating tumor cell (CTC) of HCC, nor any related study to describe the possible leading role and molecular mechanism of HCC CTCs as an important component of MVI/PVTT. In this study, we review the current understanding of MVI and possible mechanisms, discuss the function of CTCs in the formation of MVI and interaction with immune cells in the circulation. In conclusion, we discuss implications for potential therapeutic targets and the prospect of clinical treatment of HCC.
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Affiliation(s)
- Bin Sun
- Center for Clinical Research and Translational Medicine, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wei-Dan Ji
- Department of Molecular Oncology, Eastern Hepatobiliary Surgical Hospital and National Center for Liver Cancer, Navy Military Medical University, Shanghai, China
| | - Wen-Chao Wang
- Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lei Chen
- Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jun-Yong Ma
- Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Navy Military Medical University, Shanghai, China
| | - Er-Jiang Tang
- Center for Clinical Research and Translational Medicine, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Mou-Bin Lin
- Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiao-Feng Zhang
- Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Navy Military Medical University, Shanghai, China
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Zheng L, Yang C, Sheng R, Rao S, Wu L, Zeng M, Dai Y. Characterization of Microvascular Invasion in Hepatocellular Carcinoma Using Computational Modeling of Interstitial Fluid Pressure and Velocity. J Magn Reson Imaging 2023; 58:1366-1374. [PMID: 36762823 DOI: 10.1002/jmri.28644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/28/2023] [Accepted: 01/30/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Most solid tumors show increased interstitial fluid pressure (IFP), and this increased IFP is an obstacle to treatment. A noninvasive model for measuring IFP in hepatocellular carcinoma (HCC) is an unresolved issue. PURPOSE To develop a noninvasive model to measure IFP and interstitial fluid velocity (IFV) in HCC and to characterize the microvascular invasion (MVI) status by using this model. STUDY TYPE Retrospective. POPULATION A total of 97 HCC patients (mean age 57.6 ± 10.9 years, 77.3% males), 53 of them with MVI and 44 of them without MVI. FIELD STRENGTH/SEQUENCE A 3-T, three-dimensional spoiled gradient-recalled echo. ASSESSMENT MVI was defined as microscopic vascular invasion of small vessels within the peritumoral liver tissue. The volumes of interest (VOIs) were manually delineated and enclosed the tumor lesion and healthy liver parenchyma, respectively. The extended Tofts model (ETM) was used to estimate permeability parameters from all the VOIs. Subsequently, the continuity partial differential equation (PDE) was implemented and IFP and IFV were acquired. STATISTICAL TESTS Wilcoxon signed-ranks tests, histogram analysis, Mann-Whitney U test, Fisher's exact test, least absolute shrinkage and selection operator (LASSO) logistic regression, receiver operating characteristic (ROC) curve analysis with the area under the curve (AUC), Youden index, DeLong test, and Benjamini-Hochberg correction. A P value <0.05 was considered statistically significant. RESULTS The HCC lesions exhibited elevated IFP and reduced IFV. There were no significant differences in any measured demographic and clinical features between the MVI-positive and MVI-negative groups, except for tumor size. Nine IFP histogram analysis-derived parameters and seven IFV histogram analysis-derived parameters could be used to characterize the MVI status. LASSO regression selected five features: IFP maximum, IFP 10th percentile, IFP 90th percentile, IFV SD, and IFV 10th percentile. The combination of these features showed the highest AUC (0.781) and specificity (77.3%). DATA CONCLUSION A noninvasive IFP and IFV measurement model for HCC was developed. Specific IFP- and IFV-derived parameters exhibited significant association with the MVI status. EVIDENCE LEVEL 3. TECHNICAL EFFICACY Stage 2.
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Affiliation(s)
- Liyun Zheng
- Shanghai Institute of Medical Imaging, Shanghai, China
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chun Yang
- Shanghai Institute of Medical Imaging, Shanghai, China
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ruofan Sheng
- Shanghai Institute of Medical Imaging, Shanghai, China
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shengxiang Rao
- Shanghai Institute of Medical Imaging, Shanghai, China
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lifang Wu
- Shanghai Institute of Medical Imaging, Shanghai, China
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Mengsu Zeng
- Shanghai Institute of Medical Imaging, Shanghai, China
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yongming Dai
- School of Biomedical Engineering, ShanghaiTech University, Shanghai, China
- MR Collaboration, Central Research Institute, United Imaging Healthcare, Shanghai, China
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Wei X, Jiang Y, Feng S, Lu C, Huo L, Zhou B, Meng Y, Lau WY, Zheng Y, Cheng S. Neoadjuvant intensity modulated radiotherapy for a single and small (≤5 cm) hepatitis B virus-related hepatocellular carcinoma predicted to have high risks of microvascular invasion: a randomized clinical trial. Int J Surg 2023; 109:3052-3060. [PMID: 37352528 PMCID: PMC10583963 DOI: 10.1097/js9.0000000000000574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/11/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND The presence of microvascular invasion (MVI) significantly impairs postoperative long-term survival of patients with hepatocellular carcinoma (HCC). The role of neoadjuvant radiotherapy (RT) in treating patients with an early-stage HCC predicted to have high risks of MVI remains to be explored. MATERIALS AND METHODS Consecutive patients with a resectable single and small (≤5 cm) hepatitis B virus-related HCC predicted to have high risks of MVI were randomized 1:1 to receive either neoadjuvant intensity modulated radiation therapy (18 Gy with fractionated doses of 3 Gy) followed by surgery 4 weeks later or upfront surgery. The primary endpoint was disease-free survival (DFS). The secondary outcomes included overall survival (OS), objective response rate, RT-related toxicity and surgical complications. RESULTS There were 30 patients randomized to each of the two groups. In the neoadjuvant RT group, three patients violated the study protocol, with two having upfront hepatectomy and one radiofrequency ablation after RT. The objective response rate after RT was 25.0% (7/28), but 2 patients suffered from grade 3 liver toxicity. The median follow-up was 68 months (interquartile range, 58-70 months) in the neoadjuvant RT group, and 68 months (interquartile range, 62-75 months) in the upfront surgery group. On intention-to-treat analysis, the median DFS and median OS were not reached in both the 2 arms. The 1-year, 2-year, 3-year and 5-year DFS rates for the neoadjuvant RT group were 86.7%, 76.7%, 60.0% and 56.3%, versus 90.0%, 66.7%, 52.8% and 45.7% in the upfront surgery group ( P =0.448), respectively. The corresponding OS rates were 96.7%, 86.7%, 83.3% and 72.7%, versus 100.0%, 93.3%, 79.6% and 60.7% ( P = 0.399). CONCLUSION AND RELEVANCE For patients with a resectable single and small hepatitis B virus-related HCC predicted to have high risks of MVI, neoadjuvant RT gave a promising response rate with a mild toxicity. Nevertheless, the neoadjuvant RT yielded similar long-term DFS and OS rates compared with patients who underwent upfront surgery.
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Affiliation(s)
| | | | | | | | - Lei Huo
- Department of Radiology, Eastern Hepatobiliary Surgery Hospital, Navy Medical University, Shanghai
| | - Bin Zhou
- Departments of Hepatic Surgery VI
| | | | - Wan Yee Lau
- Departments of Hepatic Surgery VI
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
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Zheng X, Xu YJ, Huang J, Cai S, Wang W. Predictive value of radiomics analysis of enhanced CT for three-tiered microvascular invasion grading in hepatocellular carcinoma. Med Phys 2023; 50:6079-6095. [PMID: 37517073 DOI: 10.1002/mp.16597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 05/22/2023] [Accepted: 06/07/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Microvascular invasion (MVI) is a major risk factor, for recurrence and metastasis of hepatocellular carcinoma (HCC) after radical surgery and liver transplantation. However, its diagnosis depends on the pathological examination of the resected specimen after surgery; therefore, predicting MVI before surgery is necessary to provide reference value for clinical treatment. Meanwhile, predicting only the existence of MVI is not enough, as it ignores the degree, quantity, and distribution of MVI and may lead to MVI-positive patients suffering due to inappropriate treatment. Although some studies have involved M2 (high risk of MVI), majority have adopted the binary classification method or have not included radiomics. PURPOSE To develop three-class classification models for predicting the grade of MVI of HCC by combining enhanced computed tomography radiomics features with clinical risk factors. METHODS The data of 166 patients with HCC confirmed by surgery and pathology were analyzed retrospectively. The patients were divided into the training (116 cases) and test (50 cases) groups at a ratio of 7:3. Of them, 69 cases were MVI positive in the training group, including 45 cases in the low-risk group (M1) and 24 cases in the high-risk group (M2), and 47 cases were MVI negative (M0). In the training group, the optimal subset features were obtained through feature selection, and the arterial phase radiomics model, portal venous phase radiomics model, delayed phase radiomics model, three-phase radiomics model, clinical imaging model, and combined model were developed using Linear Support Vector Classification. The test group was used for validation, and the efficacy of each model was evaluated through the receiver operating characteristic curve (ROC). RESULTS The clinical imaging features of MVI included alpha-fetoprotein, tumor size, tumor margin, peritumoral enhancement, intratumoral artery, and low-density halo. The area under the curve (AUC) of the ROC values of the clinical imaging model for M0, M1, and M2 were 0.831, 0.701, and 0.847, respectively, in the training group and 0.782, 0.534, and 0.785, respectively, in the test group. After combined radiomics analyis, the AUC values for M0, M1, and M2 in the test group were 0.818, 0.688, and 0.867, respectively. The difference between the clinical imaging model and the combined model was statistically significant (p = 0.029). CONCLUSION The clinical imaging model and radiomics model developed in this study had a specific predictive value for HCC MVI grading, which can provide precise reference value for preoperative clinical diagnosis and treatment. The combined application of the two models had a high predictive efficacy.
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Affiliation(s)
- Xin Zheng
- Department of Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
- Department of Radiology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Yun-Jun Xu
- Department of Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Jingcheng Huang
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Shengxian Cai
- Department of Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Wanwan Wang
- Department of Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
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Zhang Y, Sheng R, Yang C, Dai Y, Zeng M. The Feasibility of Using Tri-Exponential Intra-Voxel Incoherent Motion DWI for Identifying the Microvascular Invasion in Hepatocellular Carcinoma. J Hepatocell Carcinoma 2023; 10:1659-1671. [PMID: 37799828 PMCID: PMC10547827 DOI: 10.2147/jhc.s433948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 09/21/2023] [Indexed: 10/07/2023] Open
Abstract
Purpose To assess the effectiveness of tri-exponential Intra-Voxel Incoherent Motion (tri-IVIM) MRI in preoperatively identifying microvascular invasion (MVI) in hepatocellular carcinoma (HCC). Patients and Methods In this prospective study, 67 patients with HCC were included. Metrics from bi-exponential IVIM (bi-IVIM) and tri-IVIM were calculated. Subgroup comparisons were analyzed using the independent Student's t-test or Mann-Whitney U-test. Logistic regression was performed to explore clinical risk factors. Diagnostic performance was assessed using receiver operating characteristic (ROC) curves, calibration curves and decision curve analysis. Results MVI-positive HCCs exhibited significantly lower true diffusion coefficient (Dt) from bi-IVIM, as well as fast-diffusion coefficients (Df) and slow-diffusion coefficients (Ds) from tri-IVIM, compared to MVI-negative HCCs (p < 0.05). Tumor size and alpha-fetoprotein (AFP) were identified as risk factors. The combination of tri-IVIM-derived metrics (Ds and Df) yielded higher diagnostic accuracy (AUC = 0.808) compared to bi-IVIM (AUC = 0.741). A predictive model based on a nomogram was constructed using Ds, Df, tumor size, and AFP, resulting in the highest diagnostic accuracy (AUC = 0.859). Decision curve analysis indicated that the constructed model, provided the highest net benefit by accurately stratifying the risk of MVI, followed by tri-IVIM and bi-IVIM. Conclusion Tri-IVIM can provide information on perfusion and diffusion for evaluating MVI in HCC. Additionally, tri-IVIM outperformed bi-IVIM in identifying MVI-positive HCC. By integrating clinical risk factors and metrics from tri-IVIM, a predictive nomogram exhibited the highest diagnostic accuracy, potentially aiding in the noninvasive and preoperative assessment of MVI.
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Affiliation(s)
- Yunfei Zhang
- Shanghai Institute of Medical Imaging, Fudan University, Shanghai, 200032, People’s Republic of China
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People’s Republic of China
| | - Ruofan Sheng
- Shanghai Institute of Medical Imaging, Fudan University, Shanghai, 200032, People’s Republic of China
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People’s Republic of China
| | - Chun Yang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People’s Republic of China
| | - Yongming Dai
- School of Biomedical Engineering, ShanghaiTech University, Shanghai, 200032, People’s Republic of China
| | - Mengsu Zeng
- Shanghai Institute of Medical Imaging, Fudan University, Shanghai, 200032, People’s Republic of China
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People’s Republic of China
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Chen Z, Li X, Zhang Y, Yang Y, Zhang Y, Zhou D, Yang Y, Zhang S, Liu Y. MRI Features for Predicting Microvascular Invasion and Postoperative Recurrence in Hepatocellular Carcinoma Without Peritumoral Hypointensity. J Hepatocell Carcinoma 2023; 10:1595-1608. [PMID: 37786565 PMCID: PMC10541533 DOI: 10.2147/jhc.s422632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 09/08/2023] [Indexed: 10/04/2023] Open
Abstract
Purpose To identify MRI features of hepatocellular carcinoma (HCC) that predict microvascular invasion (MVI) and postoperative intrahepatic recurrence in patients without peritumoral hepatobiliary phase (HBP) hypointensity. Patients and Methods One hundred and thirty patients with HCC who underwent preoperative gadoxetate-enhanced MRI and curative hepatic resection were retrospectively reviewed. Two radiologists reviewed all preoperative MR images and assessed the radiological features of HCCs. The ability of peritumoral HBP hypointensity to identify MVI and intrahepatic recurrence was analyzed. We then assessed the MRI features of HCC that predicted the MVI and intrahepatic recurrence-free survival (RFS) in the subgroup without peritumoral HBP hypointensity. Finally, a two-step flowchart was constructed to assist in clinical decision-making. Results Peritumoral HBP hypointensity (odds ratio, 3.019; 95% confidence interval: 1.071-8.512; P=0.037) was an independent predictor of MVI. The sensitivity, specificity, positive predictive value, negative predictive value, and AUROC of peritumoral HBP hypointensity in predicting MVI were 23.80%, 91.04%, 71.23%, 55.96%, and 0.574, respectively. Intrahepatic RFS was significantly shorter in patients with peritumoral HBP hypointensity (P<0.001). In patients without peritumoral HBP hypointensity, the only significant difference between MVI-positive and MVI-negative HCCs was the presence of a radiological capsule (P=0.038). Satellite nodule was an independent risk factor for intrahepatic RFS (hazard ratio,3.324; 95% CI: 1.733-6.378; P<0.001). The high-risk HCC detection rate was significantly higher when using the two-step flowchart that incorporated peritumoral HBP hypointensity and satellite nodule than when using peritumoral HBP hypointensity alone (P<0.001). Conclusion In patients without peritumoral HBP hypointensity, a radiological capsule is useful for identifying MVI and satellite nodule is an independent risk factor for intrahepatic RFS.
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Affiliation(s)
- Zhiyuan Chen
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, 510120, People’s Republic of China
| | - Xiaohuan Li
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, 510120, People’s Republic of China
| | - Yu Zhang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, 510120, People’s Republic of China
| | - Yiming Yang
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, 510120, People’s Republic of China
| | - Yan Zhang
- Integrated Department, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, 510120, People’s Republic of China
| | - Dongjing Zhou
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, 510120, People’s Republic of China
| | - Yu Yang
- Department of Pathology, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, 510120, People’s Republic of China
| | - Shuping Zhang
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, 510120, People’s Republic of China
| | - Yupin Liu
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, 510120, People’s Republic of China
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Cai Y, Xie K, Adeeb Alhmoud MN, Lan T, Wan H, Hu D, Lan L, Liu C, Wu H. Effect of PIVKA-II and AFP secretion status on early recurrence of hepatocellular carcinoma after open and laparoscopic surgery. Cancer Med 2023; 12:17866-17877. [PMID: 37596739 PMCID: PMC10523999 DOI: 10.1002/cam4.6422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 06/29/2023] [Accepted: 07/27/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Prothrombin induced by vitamin K absence-II (PIVKA-II) and Alpha-fetoprotein (AFP) have been widely used as diagnostic markers in hepatocellular carcinoma (HCC), but the prognostic values of the two serum markers and their clinical usefulness in patient selection for different surgical approaches remain largely unclear. METHODS HCC patients received surgical treatment between 2015 and 2019 were included. Patients were divided into four statuses according to the serum PIVKA-II and AFP secretion status: PIVKA-II (-) AFP (-) (status 1); PIVKA-II (+) AFP (-) (status 2); PIVKA-II (-) AFP (+) (status 3); PIVKA-II (+) AFP (+) (status 4). Kaplan-Meier analyses were conducted to compare the survivals of the four groups and the HCC patients received different surgical interventions; time-dependent AUC curves were introduced to evaluate the prognostic value of the PIV-AFP status; Cox regression model was used to identify prognostic indexes for overall survival (OS) and recurrence-free survival (RFS). RESULTS A total of 518 patients were included. Patients with PIVKA-II (+) and APF (+) presented significantly decreased OS and RFS comparing to the other statuses. The areas under ROC curves of PIV-AFP status in predicting OS and RFS were superior to the PIVKA-II or the AFP alone. The HCC patients in early stages with PIVKA-II (+) and APF (+) had worse RFS when received laparoscopic hepatectomy than those who received open hepatectomy, whereas there was no difference in other secretion statuses. The PIVKA-II (+) and AFP (+) secretion status was an independent risk factor for OS, RFS. CONCLUSIONS The PIV-AFP secretion status is of favorable clinical utility in predicting the OS and RFS of the HCC patients; extra caution is needed when applicated the laparoscopic approach in the HCC patients with PIVKA-II (+) and AFP (+).
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Affiliation(s)
- Yunshi Cai
- Liver Transplant Center, Transplant Center, State Key Laboratory of Biotherapy and Cancer Center, West China HospitalSichuan University and Collaborative Innovation Center of BiotherapyChengduChina
| | - Kunlin Xie
- Liver Transplant Center, Transplant Center, State Key Laboratory of Biotherapy and Cancer Center, West China HospitalSichuan University and Collaborative Innovation Center of BiotherapyChengduChina
| | - Mohammad Natheir Adeeb Alhmoud
- Liver Transplant Center, Transplant Center, State Key Laboratory of Biotherapy and Cancer Center, West China HospitalSichuan University and Collaborative Innovation Center of BiotherapyChengduChina
| | - Tian Lan
- Liver Transplant Center, Transplant Center, State Key Laboratory of Biotherapy and Cancer Center, West China HospitalSichuan University and Collaborative Innovation Center of BiotherapyChengduChina
| | - Haifeng Wan
- Liver Transplant Center, Transplant Center, State Key Laboratory of Biotherapy and Cancer Center, West China HospitalSichuan University and Collaborative Innovation Center of BiotherapyChengduChina
| | - Die Hu
- Division of Liver Surgery, Department of General SurgeryWest China Hospital, Sichuan UniversityChengduChina
| | - Ling Lan
- Division of Liver Surgery, Department of General SurgeryWest China Hospital, Sichuan UniversityChengduChina
| | - Chang Liu
- Division of Liver Surgery, Department of General SurgeryWest China Hospital, Sichuan UniversityChengduChina
- Department of Minimal Invasive SurgeryShangjin Nanfu HospitalChengduChina
| | - Hong Wu
- Liver Transplant Center, Transplant Center, State Key Laboratory of Biotherapy and Cancer Center, West China HospitalSichuan University and Collaborative Innovation Center of BiotherapyChengduChina
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Zhu Y, Feng B, Cai W, Wang B, Meng X, Wang S, Ma X, Zhao X. Prediction of Microvascular Invasion in Solitary AFP-Negative Hepatocellular Carcinoma ≤ 5 cm Using a Combination of Imaging Features and Quantitative Dual-Layer Spectral-Detector CT Parameters. Acad Radiol 2023; 30 Suppl 1:S104-S116. [PMID: 36958989 DOI: 10.1016/j.acra.2023.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 03/25/2023]
Abstract
RATIONALE AND OBJECTIVES AFP-negative hepatocellular carcinoma (AFPN-HCC) within 5 cm is a special subgroup of HCC. This study aimed to investigate the value of dual-layer spectral-detector CT (DLCT) and construct a scoring model based on imaging features as well as DLCT for predicting microvascular invasion (MVI) in AFPN-HCC within 5 cm. METHODS This retrospective study enrolled 104 HCC patients who underwent multiphase contrast-enhanced DLCT studies preoperatively. Combined radiological features (CR) and combined DLCT quantitative parameter (CDLCT) were constructed to predict MVI. Multivariable logistic regression was applied to identify potential predictors of MVI. Based on the coefficient of the regression model, a scoring model was developed. The predictive efficacy was assessed through ROC analysis. RESULTS Microvascular invasion (MVI) was found in 28 (26.9%) AFPN-HCC patients. Among single parameters, the effective atomic number in arterial phase demonstrated the best predictive efficiency for MVI with an area under the curve (AUC) of 0.792. CR and CDLCT showed predictive performance with AUCs of 0.848 and 0.849, respectively. A risk score (RS) was calculated using the independent predictors of MVI as follows: RS = 2 × (mosaic architecture) + 2 × (corona enhancement) + 2 × (incomplete tumor capsule) + 2 × (2-trait predictor of venous invasion [TTPVI]) + 3 × (CDLCT > -1.229). Delong's test demonstrated this scoring system could significantly improve the AUC to 0.929 compared with CR (p = 0.016) and CDLCT (p = 0.034). CONCLUSION The scoring model combining radiological features with DLCT provides a promising tool for predicting MVI in solitary AFPN-HCC within 5 cm preoperatively.
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Affiliation(s)
- Yongjian Zhu
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Bing Feng
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Wei Cai
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Bingzhi Wang
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing China
| | - Xuan Meng
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shuang Wang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xiaohong Ma
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Xinming Zhao
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
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Fiz F, Rossi N, Langella S, Ruzzenente A, Serenari M, Ardito F, Cucchetti A, Gallo T, Zamboni G, Mosconi C, Boldrini L, Mirarchi M, Cirillo S, De Bellis M, Pecorella I, Russolillo N, Borzi M, Vara G, Mele C, Ercolani G, Giuliante F, Ravaioli M, Guglielmi A, Ferrero A, Sollini M, Chiti A, Torzilli G, Ieva F, Viganò L. Radiomic Analysis of Intrahepatic Cholangiocarcinoma: Non-Invasive Prediction of Pathology Data: A Multicenter Study to Develop a Clinical-Radiomic Model. Cancers (Basel) 2023; 15:4204. [PMID: 37686480 PMCID: PMC10486795 DOI: 10.3390/cancers15174204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/08/2023] [Accepted: 08/16/2023] [Indexed: 09/10/2023] Open
Abstract
Standard imaging cannot assess the pathology details of intrahepatic cholangiocarcinoma (ICC). We investigated whether CT-based radiomics may improve the prediction of tumor characteristics. All consecutive patients undergoing liver resection for ICC (2009-2019) in six high-volume centers were evaluated for inclusion. On the preoperative CT, we segmented the ICC (Tumor-VOI, i.e., volume-of-interest) and a 5-mm parenchyma rim around the tumor (Margin-VOI). We considered two types of pathology data: tumor grading (G) and microvascular invasion (MVI). The predictive models were internally validated. Overall, 244 patients were analyzed: 82 (34%) had G3 tumors and 139 (57%) had MVI. For G3 prediction, the clinical model had an AUC = 0.69 and an Accuracy = 0.68 at internal cross-validation. The addition of radiomic features extracted from the portal phase of CT improved the model performance (Clinical data+Tumor-VOI: AUC = 0.73/Accuracy = 0.72; +Tumor-/Margin-VOI: AUC = 0.77/Accuracy = 0.77). Also for MVI prediction, the addition of portal phase radiomics improved the model performance (Clinical data: AUC = 0.75/Accuracy = 0.70; +Tumor-VOI: AUC = 0.82/Accuracy = 0.73; +Tumor-/Margin-VOI: AUC = 0.82/Accuracy = 0.75). The permutation tests confirmed that a combined clinical-radiomic model outperforms a purely clinical one (p < 0.05). The addition of the textural features extracted from the arterial phase had no impact. In conclusion, the radiomic features of the tumor and peritumoral tissue extracted from the portal phase of preoperative CT improve the prediction of ICC grading and MVI.
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Affiliation(s)
- Francesco Fiz
- Department of Nuclear Medicine, IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (F.F.); (M.S.); (A.C.)
| | - Noemi Rossi
- MOX Laboratory, Department of Mathematics, Politecnico di Milano, 20133 Milan, Italy; (N.R.); (F.I.)
| | - Serena Langella
- Department of Digestive and Hepatobiliary Surgery, Mauriziano Umberto I Hospital, 10128 Turin, Italy; (S.L.); (N.R.); (A.F.)
| | - Andrea Ruzzenente
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, University Hospital G.B. Rossi, 37134 Verona, Italy; (A.R.); (M.D.B.); (A.G.)
| | - Matteo Serenari
- General Surgery and Transplant Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Sant’Orsola-Malpighi Hospital, 40138 Bologna, Italy; (M.S.); (M.R.)
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy; (A.C.); (G.E.)
| | - Francesco Ardito
- Hepatobiliary Surgery Unit, A. Gemelli Hospital, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.A.); (C.M.); (F.G.)
| | - Alessandro Cucchetti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy; (A.C.); (G.E.)
- Department of General Surgery, Morgagni-Pierantoni Hospital, 47121 Forlì, Italy;
| | - Teresa Gallo
- Department of Radiology, Mauriziano Umberto I Hospital, 10128 Turin, Italy; (T.G.); (S.C.)
| | - Giulia Zamboni
- Department of Radiology, University of Verona, University Hospital G.B. Rossi, 37134 Verona, Italy; (G.Z.); (M.B.)
| | - Cristina Mosconi
- Department of Radiology, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Sant’Orsola-Malpighi Hospital, 40138 Bologna, Italy; (C.M.); (G.V.)
| | - Luca Boldrini
- Department of Radiology, Radiation Oncology and Hematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy;
| | - Mariateresa Mirarchi
- Department of General Surgery, Morgagni-Pierantoni Hospital, 47121 Forlì, Italy;
| | - Stefano Cirillo
- Department of Radiology, Mauriziano Umberto I Hospital, 10128 Turin, Italy; (T.G.); (S.C.)
| | - Mario De Bellis
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, University Hospital G.B. Rossi, 37134 Verona, Italy; (A.R.); (M.D.B.); (A.G.)
| | - Ilaria Pecorella
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy; (I.P.); (G.T.)
| | - Nadia Russolillo
- Department of Digestive and Hepatobiliary Surgery, Mauriziano Umberto I Hospital, 10128 Turin, Italy; (S.L.); (N.R.); (A.F.)
| | - Martina Borzi
- Department of Radiology, University of Verona, University Hospital G.B. Rossi, 37134 Verona, Italy; (G.Z.); (M.B.)
| | - Giulio Vara
- Department of Radiology, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Sant’Orsola-Malpighi Hospital, 40138 Bologna, Italy; (C.M.); (G.V.)
| | - Caterina Mele
- Hepatobiliary Surgery Unit, A. Gemelli Hospital, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.A.); (C.M.); (F.G.)
| | - Giorgio Ercolani
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy; (A.C.); (G.E.)
- Department of General Surgery, Morgagni-Pierantoni Hospital, 47121 Forlì, Italy;
| | - Felice Giuliante
- Hepatobiliary Surgery Unit, A. Gemelli Hospital, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.A.); (C.M.); (F.G.)
| | - Matteo Ravaioli
- General Surgery and Transplant Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Sant’Orsola-Malpighi Hospital, 40138 Bologna, Italy; (M.S.); (M.R.)
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy; (A.C.); (G.E.)
| | - Alfredo Guglielmi
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, University Hospital G.B. Rossi, 37134 Verona, Italy; (A.R.); (M.D.B.); (A.G.)
| | - Alessandro Ferrero
- Department of Digestive and Hepatobiliary Surgery, Mauriziano Umberto I Hospital, 10128 Turin, Italy; (S.L.); (N.R.); (A.F.)
| | - Martina Sollini
- Department of Nuclear Medicine, IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (F.F.); (M.S.); (A.C.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy; (I.P.); (G.T.)
| | - Arturo Chiti
- Department of Nuclear Medicine, IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (F.F.); (M.S.); (A.C.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy; (I.P.); (G.T.)
| | - Guido Torzilli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy; (I.P.); (G.T.)
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Francesca Ieva
- MOX Laboratory, Department of Mathematics, Politecnico di Milano, 20133 Milan, Italy; (N.R.); (F.I.)
- CHDS—Center for Health Data Science, Human Technopole, 20157 Milan, Italy
| | - Luca Viganò
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy; (I.P.); (G.T.)
- Hepatobiliary Unit, Department of Minimally Invasive General & Oncologic Surgery, Humanitas Gavazzeni University Hospital, 24125 Bergamo, Italy
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You H, Wang J, Ma R, Chen Y, Li L, Song C, Dong Z, Feng S, Zhou X. Clinical Interpretability of Deep Learning for Predicting Microvascular Invasion in Hepatocellular Carcinoma by Using Attention Mechanism. Bioengineering (Basel) 2023; 10:948. [PMID: 37627833 PMCID: PMC10451856 DOI: 10.3390/bioengineering10080948] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/26/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023] Open
Abstract
Preoperative prediction of microvascular invasion (MVI) is essential for management decision in hepatocellular carcinoma (HCC). Deep learning-based prediction models of MVI are numerous but lack clinical interpretation due to their "black-box" nature. Consequently, we aimed to use an attention-guided feature fusion network, including intra- and inter-attention modules, to solve this problem. This retrospective study recruited 210 HCC patients who underwent gadoxetate-enhanced MRI examination before surgery. The MRIs on pre-contrast, arterial, portal, and hepatobiliary phases (hepatobiliary phase: HBP) were used to develop single-phase and multi-phase models. Attention weights provided by attention modules were used to obtain visual explanations of predictive decisions. The four-phase fusion model achieved the highest area under the curve (AUC) of 0.92 (95% CI: 0.84-1.00), and the other models proposed AUCs of 0.75-0.91. Attention heatmaps of collaborative-attention layers revealed that tumor margins in all phases and peritumoral areas in the arterial phase and HBP were salient regions for MVI prediction. Heatmaps of weights in fully connected layers showed that the HBP contributed the most to MVI prediction. Our study firstly implemented self-attention and collaborative-attention to reveal the relationship between deep features and MVI, improving the clinical interpretation of prediction models. The clinical interpretability offers radiologists and clinicians more confidence to apply deep learning models in clinical practice, helping HCC patients formulate personalized therapies.
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Affiliation(s)
| | | | | | | | | | | | | | - Shiting Feng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58th the Second Zhongshan Road, Guangzhou 510080, China; (H.Y.); (J.W.); (R.M.); (Y.C.); (L.L.); (C.S.); (Z.D.)
| | - Xiaoqi Zhou
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58th the Second Zhongshan Road, Guangzhou 510080, China; (H.Y.); (J.W.); (R.M.); (Y.C.); (L.L.); (C.S.); (Z.D.)
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Kang WH, Hwang S, Kaibori M, Kim JM, Kim KS, Kobayashi T, Kayashima H, Koh YS, Kubota K, Mori A, Takeda Y, Yun SS, Matsui K, Toriguchi K, Nagano H, Yoon MH, Soejima Y, Ariizumi S, Kim BS, Park Y, Yu HC, Kim BW, Lee JB, Park SJ, Jang JY, Yamaue H, Nakamura M, Yamamoto M, Endo I. Validation of quantitative prognostic prediction using ADV score for resection of hepatocellular carcinoma: A Korea-Japan collaborative study with 9200 patients. J Hepatobiliary Pancreat Sci 2023; 30:993-1005. [PMID: 36808234 DOI: 10.1002/jhbp.1319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 02/02/2023] [Accepted: 02/10/2023] [Indexed: 02/21/2023]
Abstract
BACKGROUND A score derived from the concentrations of α-fetoprotein (AFP) and des-γ-carboxy prothrombin (DCP) and tumor volume (TV), called ADV score, has been shown to be prognostic of hepatocellular carcinoma (HCC) recurrence following hepatic resection (HR) or liver transplantation. METHODS This multicenter, multinational validation study included 9200 patients who underwent HR from 2010 to 2017 at 10 Korean and 73 Japanese centers, and were followed up until 2020. RESULTS AFP, DCP, and TV showed weak correlations (ρ ≤ .463, r ≤ .189, p < .001). Disease-free survival (DFS), overall survival (OS), and post-recurrence survival rates were dependent on 1.0 log and 2.0 log intervals of ADV scores (p < .001). Receiver operating characteristic (ROC) curve analysis showed that ADV score cutoffs of 5.0 log for DFS and OS yielded the areas under the curve ≥ .577, with both being significantly prognostic of tumor recurrence and patient mortality at 3 years. ADV score cutoffs of ADV 4.0 log and 8.0 log, derived through K-adaptive partitioning method, showed higher prognostic contrasts in DFS and OS. ROC curve analysis showed that an ADV score cutoff of 4.2 log was suggestive of microvascular invasion, with both microvascular invasion and an ADV score cutoff of 4.2 log showing similar DFS rates. CONCLUSIONS This international validation study demonstrated that ADV score is an integrated surrogate biomarker for post-resection prognosis of HCC. Prognostic prediction using ADV score can provide reliable information that can assist in planning treatment of patients with different stages of HCC and guide individualized post-resection follow-up based on the relative risk of HCC recurrence.
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Affiliation(s)
- Woo-Hyoung Kang
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Shin Hwang
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Masaki Kaibori
- Department of Surgery, Kansai Medical University, Hirakata, Japan
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyung Sik Kim
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Tsuyoshi Kobayashi
- Department of Gastroenterological Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | | | - Yang Seok Koh
- Department of Surgery, Hwasun Chonnam National University Hospital and Medical School, Gwangju, South Korea
| | - Keiichi Kubota
- Second Department of Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Akira Mori
- Department of Surgery, Japanese Red Cross Osaka Hospital, Osaka, Japan
| | - Yutaka Takeda
- Department of Surgery, Kansai Rosai Hospital, Amagasaki, Japan
| | - Sung Su Yun
- Department of Surgery, Yeungnam University Medical Center, Daegu, South Korea
| | - Kousuke Matsui
- Department of Surgery, Kansai Medical University, Hirakata, Japan
| | - Kan Toriguchi
- Department of Gastroenterological Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hiroaki Nagano
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Myung Hee Yoon
- Department of Surgery, Pusan National University Hospital, Kumjeong-ku, South Korea
| | - Yuji Soejima
- Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shunichi Ariizumi
- Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Bum-Soo Kim
- Department of Surgery, Kyung Hee University Medical Center, Seoul, South Korea
| | - Yohan Park
- Department of Surgery, Inje University Busan Paik Hospital, Busan, South Korea
| | - Hee Chul Yu
- Department of Surgery, Jeonbuk National University Hospital, Jeonju, South Korea
| | - Bong Wan Kim
- Department of Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Jung Bok Lee
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sang-Jae Park
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, South Korea
| | - Jin-Young Jang
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Hiroki Yamaue
- Second Department of Surgery, Wakayama Medical University, Wakayama, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Itaru Endo
- Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
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Li Z, Wang Y, Zhu Y, Xu J, Wei J, Xie J, Zhang J. Modality-based attention and dual-stream multiple instance convolutional neural network for predicting microvascular invasion of hepatocellular carcinoma. Front Oncol 2023; 13:1195110. [PMID: 37434971 PMCID: PMC10331018 DOI: 10.3389/fonc.2023.1195110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/30/2023] [Indexed: 07/13/2023] Open
Abstract
Background and purpose The presence of microvascular invasion (MVI) is a crucial indicator of postoperative recurrence in patients with hepatocellular carcinoma (HCC). Detecting MVI before surgery can improve personalized surgical planning and enhance patient survival. However, existing automatic diagnosis methods for MVI have certain limitations. Some methods only analyze information from a single slice and overlook the context of the entire lesion, while others require high computational resources to process the entire tumor with a three-dimension (3D) convolutional neural network (CNN), which could be challenging to train. To address these limitations, this paper proposes a modality-based attention and dual-stream multiple instance learning(MIL) CNN. Materials and methods In this retrospective study, 283 patients with histologically confirmed HCC who underwent surgical resection between April 2017 and September 2019 were included. Five magnetic resonance (MR) modalities including T2-weighted, arterial phase, venous phase, delay phase and apparent diffusion coefficient images were used in image acquisition of each patient. Firstly, Each two-dimension (2D) slice of HCC magnetic resonance image (MRI) was converted into an instance embedding. Secondly, modality attention module was designed to emulates the decision-making process of doctors and helped the model to focus on the important MRI sequences. Thirdly, instance embeddings of 3D scans were aggregated into a bag embedding by a dual-stream MIL aggregator, in which the critical slices were given greater consideration. The dataset was split into a training set and a testing set in a 4:1 ratio, and model performance was evaluated using five-fold cross-validation. Results Using the proposed method, the prediction of MVI achieved an accuracy of 76.43% and an AUC of 74.22%, significantly surpassing the performance of the baseline methods. Conclusion Our modality-based attention and dual-stream MIL CNN can achieve outstanding results for MVI prediction.
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Affiliation(s)
- Zhi Li
- School of Medicine, Shanghai University, Shanghai, China
- Shanghai Universal Medical Imaging Diagnostic Center, Shanghai University, Shanghai, China
| | - Yutao Wang
- The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Yuzhao Zhu
- Shanghai Universal Medical Imaging Diagnostic Center, Shanghai University, Shanghai, China
| | - Jiafeng Xu
- Shanghai Universal Medical Imaging Diagnostic Center, Shanghai University, Shanghai, China
| | - Jinzhu Wei
- School of Medicine, Shanghai University, Shanghai, China
| | - Jiang Xie
- School of Computer Engineering and Science, Shanghai University, Shanghai, China
| | - Jian Zhang
- Shanghai Universal Medical Imaging Diagnostic Center, Shanghai University, Shanghai, China
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Yang P, Teng F, Bai S, Xia Y, Xie Z, Cheng Z, Li J, Lei Z, Wang K, Zhang B, Yang T, Wan X, Yin H, Shen H, Pawlik TM, Lau WY, Fu Z, Shen F. Liver resection versus liver transplantation for hepatocellular carcinoma within the Milan criteria based on estimated microvascular invasion risks. Gastroenterol Rep (Oxf) 2023; 11:goad035. [PMID: 37384119 PMCID: PMC10293589 DOI: 10.1093/gastro/goad035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 05/03/2023] [Accepted: 05/25/2023] [Indexed: 06/30/2023] Open
Abstract
Background Preoperative prediction of microvascular invasion (MVI) in hepatocellular carcinoma (HCC) may optimize individualized treatment decision-making. This study aimed to investigate the prognostic differences between HCC patients undergoing liver resection (LR) and liver transplantation (LT) based on predicted MVI risks. Methods We analysed 905 patients who underwent LR, including 524 who underwent anatomical resection (AR) and 117 who underwent LT for HCC within the Milan criteria using propensity score matching. A nomogram model was used to predict preoperative MVI risk. Results The concordance indices of the nomogram for predicting MVI were 0.809 and 0.838 in patients undergoing LR and LT, respectively. Based on an optimal cut-off value of 200 points, the nomogram defined patients as high- or low-risk MVI groups. LT resulted in a lower 5-year recurrence rate and higher 5-year overall survival (OS) rate than LR among the high-risk patients (23.6% vs 73.2%, P < 0.001; 87.8% vs 48.1%, P < 0.001) and low-risk patients (19.0% vs 45.7%, P < 0.001; 86.5% vs 70.0%, P = 0.002). The hazard ratios (HRs) of LT vs LR for recurrence and OS were 0.18 (95% confidence interval [CI], 0.09-0.37) and 0.12 (95% CI, 0.04-0.37) among the high-risk patients and 0.37 (95% CI, 0.21-0.66) and 0.36 (95% CI, 0.17-0.78) among the low-risk patients. LT also provided a lower 5-year recurrence rate and higher 5-year OS rate than AR among the high-risk patients (24.8% vs 63.5%, P = 0.001; 86.7% vs 65.7%, P = 0.004), with HRs of LT vs AR for recurrence and OS being 0.24 (95% CI, 0.11-0.53) and 0.17 (95% CI, 0.06-0.52), respectively. The 5-year recurrence and OS rates between patients undergoing LT and AR were not significantly different in the low-risk patients (19.4% vs 28.3%, P = 0.129; 85.7% vs 77.8%, P = 0.161). Conclusions LT was superior to LR for patients with HCC within the Milan criteria with a predicted high or low risk of MVI. No significant differences in prognosis were found between LT and AR in patients with a low risk of MVI.
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Affiliation(s)
| | | | | | - Yong Xia
- Department of Hepatic Surgery IV and Clinical Research Institute, The Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, P. R. China
| | - Zhihao Xie
- Department of Hepatic Surgery IV and Clinical Research Institute, The Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, P. R. China
| | - Zhangjun Cheng
- Department of Hepatic Surgery IV and Clinical Research Institute, The Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, P. R. China
- Department of General Surgery, The Affiliated Zhongda Hospital, Southeast University, Nanjing, Jiangsu, P. R. China
| | - Jun Li
- Department of Hepatic Surgery IV and Clinical Research Institute, The Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, P. R. China
| | - Zhengqing Lei
- Department of Hepatic Surgery IV and Clinical Research Institute, The Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, P. R. China
- Department of General Surgery, The Affiliated Zhongda Hospital, Southeast University, Nanjing, Jiangsu, P. R. China
| | - Kui Wang
- Department of Hepatic Surgery II and Clinical Research Institute, The Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, P. R. China
| | - Baohua Zhang
- Department of Biliary Surgery IV and Clinical Research Institute, The Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, P. R. China
| | - Tian Yang
- Department of Hepatic Surgery II and Clinical Research Institute, The Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, P. R. China
| | - Xuying Wan
- Department of Chinese Traditional Medicine, The Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, P. R. China
| | - Hao Yin
- Department of Liver Surgery and Organ Transplantation, The Changzheng Hospital, Naval Medical University, Shanghai, P. R. China
| | - Hao Shen
- Department of Hepatic Surgery IV and Clinical Research Institute, The Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, P. R. China
| | - Timothy M Pawlik
- Department of Surgery, The Wexner Medical Center, Ohio State University, Columbus, OH, USA
| | - Wan Yee Lau
- Department of Hepatic Surgery IV and Clinical Research Institute, The Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, P. R. China
- Faculty of Medicine, the Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - Zhiren Fu
- Corresponding authors. Feng Shen, Department of Hepatic Surgery IV and Clinical Research Institute, The Eastern Hepatobiliary Surgery Hospital, Naval Medical University, 225 Changhai Road, Shanghai, 200433, China. Tel: +86-21-81875005; Fax: +86-21-65562400; ; Zhiren Fu, Department of Liver Surgery and Organ Transplantation, The Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China. Tel: +86-21-81885741; Fax: +86-21-63276788;
| | - Feng Shen
- Corresponding authors. Feng Shen, Department of Hepatic Surgery IV and Clinical Research Institute, The Eastern Hepatobiliary Surgery Hospital, Naval Medical University, 225 Changhai Road, Shanghai, 200433, China. Tel: +86-21-81875005; Fax: +86-21-65562400; ; Zhiren Fu, Department of Liver Surgery and Organ Transplantation, The Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China. Tel: +86-21-81885741; Fax: +86-21-63276788;
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Gong G, Cao S, Xiao H, Fang W, Que Y, Liu Z, Chen C. [Prediction of microvascular invasion in hepatocellular carcinoma with magnetic resonance imaging using models combining deep attention mechanism with clinical features]. Nan Fang Yi Ke Da Xue Xue Bao 2023; 43:839-851. [PMID: 37313827 DOI: 10.12122/j.issn.1673-4254.2023.05.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To investigate the consistency and diagnostic performance of magnetic resonance imaging (MRI) for detecting microvascular invasion (MVI) of hepatocellular carcinoma (HCC) and the validity of deep learning attention mechanisms and clinical features for MVI grade prediction. METHODS This retrospective study was conducted among 158 patients with HCC treated in Shunde Hospital Affiliated to Southern Medical University between January, 2017 and February, 2020. The imaging data and clinical data of the patients were collected to establish single sequence deep learning models and fusion models based on the EfficientNetB0 and attention modules. The imaging data included conventional MRI sequences (T1WI, T2WI, and DWI), enhanced MRI sequences (AP, PP, EP, and HBP) and synthesized MRI sequences (T1mapping-pre and T1mapping-20 min), and the high-risk areas of MVI were visualized using deep learning visualization techniques. RESULTS The fusion model based on T1mapping-20min sequence and clinical features outperformed other fusion models with an accuracy of 0.8376, a sensitivity of 0.8378, a specificity of 0.8702, and an AUC of 0.8501 for detecting MVI. The deep fusion models were also capable of displaying the high-risk areas of MVI. CONCLUSION The fusion models based on multiple MRI sequences can effectively detect MVI in patients with HCC, demonstrating the validity of deep learning algorithm that combines attention mechanism and clinical features for MVI grade prediction.
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Affiliation(s)
- G Gong
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China
| | - S Cao
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China
| | - H Xiao
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China
| | - W Fang
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China
| | - Y Que
- First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Z Liu
- Shunde Hospital Affiliated to Southern Medical University, Foshan 528308, China
| | - C Chen
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China
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Nimitrungtawee N, Inmutto N, Amantakul A, Jantarangkoon A. Prediction microvascular invasion of hepatocellular carcinoma based on tumour margin enhancing pattern in multiphase computed tomography images. Pol J Radiol 2023; 88:e238-e243. [PMID: 37346425 PMCID: PMC10280366 DOI: 10.5114/pjr.2023.127578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/12/2023] [Indexed: 06/23/2023] Open
Abstract
Purpose The presence of microvascular invasion of hepatocellular carcinoma has a significantly decreased outcome following hepatectomy or liver transplantation. Currently, it is still based on histological examination. Identification of microvascular invasion by using pre-operative imaging is important for the decision-making of surgeons and interventional radiologists. Aim of the study was to predict the microvascular invasion of hepatocellular carcinoma based on tumour margin enhancement of pre-operative multiphase computed tomography (CT) images. Material and methods Fifty-three patients with hepatocellular carcinoma, who underwent pre-operative multiphase CT scans, were included in this study. Tumour margin enhancing patterns were analysed in the late arterial phase, portovenous phase, and delay phase. The CT features including peritumoral enhancement, arterial rim-enhancement, presence of daughter nodules, complete capsule enhancement in portovenous/delay phase, and nodular capsule enhancement in portovenous/delay phase were reviewed with calculations for sensitivity and specificity. Univariate analysis and multivariate analysis were used to identify predictive features for microvascular invasion (MVI). Results In the late arterial phase, peritumoral enhancement or the presence of daughter nodules were not predictors for MVI. Nodular capsule enhancement in the portovenous phase and delay phase were independent predictors for MVI with odds ratios of 29.25 and 33.09, respectively. The sensitivity and specificity for incomplete/nodular capsule enhancement in the portovenous phase were 69.23% and 96.86%, respectively. The sensitivity and specificity for incomplete/nodular capsule enhancement in the delay phase were 71.79% and 96.86%, respectively. Conclusion Nodular capsule enhancement in the portovenous phase or delay phase was a good predictor for MVI.
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Affiliation(s)
| | - Nakarin Inmutto
- Correspondence address: Nakarin Inmutto, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand, e-mail:
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Xu XF, Diao YK, Zeng YY, Li C, Li FW, Sun LY, Wu H, Lin KY, Yao LQ, Wang MD, Zhang CW, Lau WY, Shen F, Yang T. Association of severity in the grading of microvascular invasion with long-term oncological prognosis after liver resection for early-stage hepatocellular carcinoma: a multicenter retrospective cohort study from a hepatitis B virus-endemic area. Int J Surg 2023; 109:841-849. [PMID: 36974673 PMCID: PMC10389398 DOI: 10.1097/js9.0000000000000325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/26/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND The presence of microvascular invasion (MVI) is a significant malignant pathological feature related to recurrence and survival after liver resection for hepatocellular carcinoma (HCC). This study aimed to investigate the relationship between the severity in the grading of MVI and long-term oncological outcomes in patients with early-stage HCC. METHODS A retrospective study was conducted on a prospectively maintained multicenter database on patients who underwent curative resection for Barcelona Clinic Liver Cancer stage 0/A HCC between 2017 and 2020. Patients were classified into three groups according to the severity in the grading of MVI: M0 (no MVI), M1 (1-5 sites of MVI occurring ≤1 cm away from the tumor), and M2 (>5 sites occurring ≤1 cm and/or any site occurring >1 cm away from the tumor). Recurrence-free survival (RFS) and overall survival (OS) were compared among the groups. RESULTS Of 388 patients, M0, M1, and M2 of the MVI gradings were present in 223 (57.5%), 118 (30.4%), and 47 (12.1%) patients, respectively. The median OS and RFS in patients with M0, M1, and M2 were 61.1, 52.7, and 27.4 months; and 43.0, 29.1, and 13.1 months (both P <0.001), respectively. Multivariable analyses identified both M1 and M2 to be independent risk factors for OS [hazard ratio (HR): 1.682, P =0.003; and HR: 3.570, P <0.001] and RFS (HR: 1.550, P =0.037; and HR: 2.256, P <0.001). CONCLUSION The severity in the grading of MVI was independently associated with recurrence and survival after HCC resection. Patients with the presence of MVI, especially those with a more severe MVI grading (M2), require more stringent recurrence surveillance and/or active adjuvant therapy against recurrence.
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Affiliation(s)
- Xin-Fei Xu
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University (Second Military Medical University)
- Eastern Hepatobiliary Clinical Research Institute, Third Affiliated Hospital of Naval Medical University
| | - Yong-Kang Diao
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University (Second Military Medical University)
| | - Yong-Yi Zeng
- Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital, Fujian Medical University, Fujian
| | - Chao Li
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University (Second Military Medical University)
| | - Feng-Wei Li
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University (Second Military Medical University)
| | - Li-Yang Sun
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, Cancer Centre, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang
| | - Han Wu
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University (Second Military Medical University)
- Eastern Hepatobiliary Clinical Research Institute, Third Affiliated Hospital of Naval Medical University
| | - Kong-Ying Lin
- Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital, Fujian Medical University, Fujian
| | - Lan-Qing Yao
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University (Second Military Medical University)
| | - Ming-Da Wang
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University (Second Military Medical University)
| | - Cheng-Wu Zhang
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, Cancer Centre, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang
| | - Wan Yee Lau
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University (Second Military Medical University)
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Feng Shen
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University (Second Military Medical University)
- Eastern Hepatobiliary Clinical Research Institute, Third Affiliated Hospital of Naval Medical University
| | - Tian Yang
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University (Second Military Medical University)
- Eastern Hepatobiliary Clinical Research Institute, Third Affiliated Hospital of Naval Medical University
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, Cancer Centre, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang
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Zhang XP, Xu S, Lin ZY, Gao QL, Wang K, Chen ZL, Yan ML, Zhang F, Tang YF, Zhao ZM, Li CG, Lau WY, Cheng SQ, Hu MG, Liu R. Significance of anatomical resection and resection margin status in patients with HBV-related hepatocellular carcinoma and microvascular invasion: a multicenter propensity score-matched study. Int J Surg 2023; 109:679-688. [PMID: 36917129 PMCID: PMC10389431 DOI: 10.1097/js9.0000000000000204] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 01/02/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Microvascular invasion (MVI) is a risk factor for postoperative survival outcomes for patients with hepatocellular carcinoma (HCC) after hepatectomy. This study aimed to evaluate the impact of anatomical resection (AR) versus nonanatomical resection (NAR) combined with resection margin (RM) (narrow RM <1 cm vs. wide RM ≥1 cm) on long-term prognosis in hepatitis B virus-related HCC patients with MVI. MATERIALS AND METHODS Data from multicenters on HCC patients with MVI who underwent hepatectomy was analyzed retrospectively. Propensity score matching analysis was performed in these patients. RESULTS The 1965 enrolled patients were divided into four groups: AR with wide RM ( n =715), AR with narrow RM ( n =387), NAR with wide RM ( n =568), and NAR with narrow RM ( n =295). Narrow RM ( P <0.001) and NAR ( P <0.001) were independent risk factors for both overall survival and recurrence-free survival in these patients based on multivariate analyses. For patients in both the AR and NAR groups, wide RM resulted in significantly lower operative margin recurrence rates than those patients in the narrow RM groups after propensity score matching ( P =0.002 and 0.001). Patients in the AR with wide RM group had significantly the best median overall survival (78.9 vs. 51.5 vs. 48.0 vs. 36.7 months, P <0.001) and recurrence-free survival (23.6 vs. 14.8 vs. 17.8 vs. 9.0 months, P <0.001) than those in the AR with narrow RM, NAR with wide RM or with narrow RM groups, respectively. CONCLUSIONS If technically feasible and safe, AR combined with wide RM should be the recommended therapeutic strategy for HCC patients who are estimated preoperatively with a high risk of MVI.
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Affiliation(s)
- Xiu-Ping Zhang
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People’s Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, Key Laboratory of Digital Hepatobiliary Surgery, PLA, Beijing
| | - Shuai Xu
- Department of Liver Transplantation and Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan
| | - Zhao-Yi Lin
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People’s Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, Key Laboratory of Digital Hepatobiliary Surgery, PLA, Beijing
| | - Qing-Lun Gao
- Department of Hepatobiliary Surgery, Shandong Provincial Third Hospital, Cheeloo College of Medicine, Shandong University, Shandong
| | - Kang Wang
- Department of Hepatobiliary Surgery, Affiliated Hospital of Binzhou Medical College, Shandong
| | - Zi-Li Chen
- Department of Hepatobiliary Surgery, Affiliated Hospital of Guizhou Medical University, Guizhou
| | - Mao-Lin Yan
- Department of Hepato-Biliary-Pancreatic Surgery, Fujian Provincial Hospital, Fujian
| | - Fan Zhang
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai
| | - Yu-Fu Tang
- Department of Hepatobiliary Surgery, Northern Theater General Hospital, Liaoning
| | - Zhi-Ming Zhao
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People’s Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, Key Laboratory of Digital Hepatobiliary Surgery, PLA, Beijing
| | - Cheng-Gang Li
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People’s Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, Key Laboratory of Digital Hepatobiliary Surgery, PLA, Beijing
| | - Wan Yee Lau
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People’s Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, Key Laboratory of Digital Hepatobiliary Surgery, PLA, Beijing
- Faculty of Medicine, the Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China
| | - Shu-Qun Cheng
- Department of Hepatobiliary Surgery, Affiliated Hospital of Binzhou Medical College, Shandong
| | - Ming-Gen Hu
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People’s Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, Key Laboratory of Digital Hepatobiliary Surgery, PLA, Beijing
| | - Rong Liu
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People’s Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, Key Laboratory of Digital Hepatobiliary Surgery, PLA, Beijing
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Luo L, Shan R, Cui L, Wu Z, Qian J, Tu S, Zhang W, Xiong Y, Lin W, Tang H, Zhang Y, Zhu J, Huang Z, Li Z, Mao S, Li H, Hu Z, Peng P, He K, Li Y, Liu L, Shen W, He Y. Postoperative adjuvant transarterial chemoembolisation improves survival of hepatocellular carcinoma patients with microvascular invasion: A multicenter retrospective cohort. United European Gastroenterol J 2023; 11:228-241. [PMID: 36905230 PMCID: PMC10039794 DOI: 10.1002/ueg2.12365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/30/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND We aimed to investigate the efficacy of postoperative adjuvant transarterial chemoembolisation (PA-TACE) in patients with hepatocellular carcinoma (HCC) complicated by microvascular invasion (MVI). METHODS A retrospective analysis of 1505 patients with HCC who underwent hepatectomy at four medical centers, including 782 patients who received PA-TACE and 723 patients who did not receive adjuvant PA-TACE, has been conducted. Propensity score matching (PSM) (1:1) was performed on the data to minimise selection bias, which resulted in a balanced clinical profile between groups. RESULTS After PSM, 620 patients who received PA-TACE and 620 patients who did not receive PA-TACE were included. Disease-free survival (DFS, 1-, 2-, and 3-year: 88%-68%-61% vs. 70%-58%-51%, p < 0.001) and overall survival (OS, 1-, 2-, and 3-year: 96%-89%-82% vs. 89%-77%-67%, p < 0.001) were significantly higher in patients who received PA-TACE than in those who did not. Patients with MVI who received PA-TACE had significantly higher DFS (1-, 2-, and 3-year: 68%-57%-48% vs. 46%-31%-27%, p < 0.001) and OS (1-, 2-, and 3-year: 96%-84%-77% vs. 79%-58%-40%, p < 0.001) than those who did not receive PA-TACE. Among the six different liver cancer stages, MVI-negative patients did not have significant survival outcomes from PA-TACE (p > 0.05), whereas MVI-positive patients achieved higher DFS and OS from it (p < 0.05). Liver dysfunction, fever, and nausea/vomiting were the most common adverse events in patients receiving PA-TACE. There was no significant difference in grade 3 or 4 adverse events between the groups (p > 0.05). CONCLUSIONS Postoperative adjuvant transarterial chemoembolisation has a good safety profile and may be a potentially beneficial treatment modality for survival outcomes in patients with HCC, especially those with concomitant MVI.
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Affiliation(s)
- Laihui Luo
- Division of Hepatobiliary and Pancreas Surgery, Department of General Surgery, The First Affiliated Hospital of Nanchang University (The First Clinical Medical College of Nanchang University), Nanchang City, Jiangxi Province, China
| | - Renfeng Shan
- Division of Hepatobiliary and Pancreas Surgery, Department of General Surgery, The First Affiliated Hospital of Nanchang University (The First Clinical Medical College of Nanchang University), Nanchang City, Jiangxi Province, China
| | - Lifeng Cui
- Division of Hepatobiliary and Pancreas Surgery, Department of General Surgery, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen City, Guangdong Province, China
- Maoming People's Hospital, Maoming, China
| | - Zhao Wu
- Department of General Surgery, the Second Affiliated Hospital of Nanchang University (The Second Clinical Medical College of Nanchang University), Nanchang City, Jiangxi Province, China
| | - Junlin Qian
- Department of Hepatobiliary Surgery, Zhongshan People's Hospital (Zhongshan Hospital Affiliated to Sun Yat-sen University), Zhongshan City, Guangdong Province, China
| | - Shuju Tu
- Division of Hepatobiliary and Pancreas Surgery, Department of General Surgery, The First Affiliated Hospital of Nanchang University (The First Clinical Medical College of Nanchang University), Nanchang City, Jiangxi Province, China
| | - WenJian Zhang
- Department of General Surgery, the Second Affiliated Hospital of Nanchang University (The Second Clinical Medical College of Nanchang University), Nanchang City, Jiangxi Province, China
| | - Yuanpeng Xiong
- Division of Hepatobiliary and Pancreas Surgery, Department of General Surgery, The First Affiliated Hospital of Nanchang University (The First Clinical Medical College of Nanchang University), Nanchang City, Jiangxi Province, China
| | - Wei Lin
- Department of Hepatobiliary Surgery, Zhongshan People's Hospital (Zhongshan Hospital Affiliated to Sun Yat-sen University), Zhongshan City, Guangdong Province, China
| | - Hongtao Tang
- Department of Hepatobiliary Surgery, Zhongshan People's Hospital (Zhongshan Hospital Affiliated to Sun Yat-sen University), Zhongshan City, Guangdong Province, China
| | - Yang Zhang
- Division of Hepatobiliary and Pancreas Surgery, Department of General Surgery, The First Affiliated Hospital of Nanchang University (The First Clinical Medical College of Nanchang University), Nanchang City, Jiangxi Province, China
| | - Jisheng Zhu
- Division of Hepatobiliary and Pancreas Surgery, Department of General Surgery, The First Affiliated Hospital of Nanchang University (The First Clinical Medical College of Nanchang University), Nanchang City, Jiangxi Province, China
| | - Zeyu Huang
- Department of General Surgery, the Second Affiliated Hospital of Nanchang University (The Second Clinical Medical College of Nanchang University), Nanchang City, Jiangxi Province, China
| | - Zhigang Li
- Department of General Surgery, the Second Affiliated Hospital of Nanchang University (The Second Clinical Medical College of Nanchang University), Nanchang City, Jiangxi Province, China
| | - Shengping Mao
- Department of General Surgery, the Second Affiliated Hospital of Nanchang University (The Second Clinical Medical College of Nanchang University), Nanchang City, Jiangxi Province, China
| | - Hui Li
- School of Public Health, Nanchang University, Nanchang, China
| | - Zemin Hu
- Department of Hepatobiliary Surgery, Zhongshan People's Hospital (Zhongshan Hospital Affiliated to Sun Yat-sen University), Zhongshan City, Guangdong Province, China
| | - Peng Peng
- Department of Hepatobiliary Surgery, Zhongshan People's Hospital (Zhongshan Hospital Affiliated to Sun Yat-sen University), Zhongshan City, Guangdong Province, China
| | - Kun He
- Department of Hepatobiliary Surgery, Zhongshan People's Hospital (Zhongshan Hospital Affiliated to Sun Yat-sen University), Zhongshan City, Guangdong Province, China
| | - Yong Li
- Division of Hepatobiliary and Pancreas Surgery, Department of General Surgery, The First Affiliated Hospital of Nanchang University (The First Clinical Medical College of Nanchang University), Nanchang City, Jiangxi Province, China
| | - Liping Liu
- Division of Hepatobiliary and Pancreas Surgery, Department of General Surgery, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen City, Guangdong Province, China
| | - Wei Shen
- Department of General Surgery, the Second Affiliated Hospital of Nanchang University (The Second Clinical Medical College of Nanchang University), Nanchang City, Jiangxi Province, China
| | - Yongzhu He
- Division of Hepatobiliary and Pancreas Surgery, Department of General Surgery, The First Affiliated Hospital of Nanchang University (The First Clinical Medical College of Nanchang University), Nanchang City, Jiangxi Province, China
- Department of Hepatobiliary Surgery, Zhongshan People's Hospital (Zhongshan Hospital Affiliated to Sun Yat-sen University), Zhongshan City, Guangdong Province, China
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Liu H, Bai Y, Li F, Tian Z. Combined serum CXCL8, CXCL9 and CXCL13 tests for the prediction of microvascular invasion in hepatocellular carcinoma. Biomark Med 2023; 17:265-272. [PMID: 37218545 DOI: 10.2217/bmm-2023-0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
Aim: This work is to explore the predictive and diagnostic value of chemokine C-X-C motif ligand 8 (CXCL8), CXCL9 and CXCL13 combined detections for microvascular invasion (MVI) in hepatocellular carcinoma (HCC) patients. Materials & methods: A total of 82 HCC patients with MVI were recruited as the MVI group and 154 patients with non MVI were recruited as the non MVI group. Results: In HCC patients with MVI, CXCL8, CXCL9, CXCL13 levels were significantly elevated. Child-Pugh scores and serum α-fetoprotein level had positive correlation with CXCL8, CXCL9 and CXCL13 levels. The serum levels of CXCL8, 9 and 13 were effective in predicting MVI in HCC patients. Conclusion: CXCL8, CXCL9 and CXCL13 levels in HCC patients are valuable parameters in the prediction of MVI.
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Affiliation(s)
- Hong Liu
- Department of General Surgery, Fifth People's Hospital, No. 1215 Guangrui Road, Liangxi District, Wuxi, Jiangsu, 214007, China
| | - Yang Bai
- Department of Hepatobiliary Surgery, the 904th Hospital of Joint Logistic Support Force of PLA, No. 101 Xingyuan North Road, Wuxi, Jiangsu, 214044, China
| | - Fuli Li
- Department of General Surgery, Fifth People's Hospital, No. 1215 Guangrui Road, Liangxi District, Wuxi, Jiangsu, 214007, China
| | - Zhiqiang Tian
- Department of General Surgery, the Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, Jiangsu, 214000, China
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Wu Y, Liu H, Chen Y, Zeng J, Huang Q, Zhang J, Zeng Y, Liu J. Prognostic significance of three-tiered pathological classification for microvascular invasion in patients with combined hepatocellular-cholangiocarcinoma following hepatic resection. Cancer Med 2023; 12:5233-5244. [PMID: 36354141 PMCID: PMC10028161 DOI: 10.1002/cam4.5328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 08/01/2022] [Accepted: 09/12/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Previous studies have reported that the microvascular invasion three-tiered grading (MiVI-TTG) scheme is a better prognostic predictor than the two-tiered microvascular invasion (MiVI) grading scheme in hepatocellular carcinoma. This study aims to explore the prognostic significance of MiVI-TTG in patients undergoing liver resection for combined hepatocellular-cholangiocarcinoma (cHCC) and to explore the risk factors for MiVI in cHCC. METHODS This research included 208 patients graded as M0, M1, or M2 using the MiVI-TTG scheme. Predictive performance was assessed by Cox regression analysis, Kaplan-Meier curve with Log rank test, Harrell's c-index, and time-dependent areas under the receiver operating characteristic curve (tdAUC). The clinical utility of the two schemes was evaluated by decision cure analysis (DCA). The risk factors for MiVI were evaluated using logistic regression analysis. RESULTS Among 208 cHCC patients, the proportions of M0, M1 and M2 were 38.9%, 36.5%, and 24.5%, respectively. Patients with severe MiVI status had worse recurrence-free survival and overall survival (OS) based on Kaplan-Meier analysis. M1, M2, and MiVI-positive were independent risk factors for early recurrence, while M2 and MiVI-positive were associated with overall survival (OS). MiVI-TTG had a larger c-index, tdAUC, and net benefit rate than the two-tiered MiVI grading scheme for predicting recurrence free survival and OS. AFP≥400 ng/ml was the independent risk factor for MiVI, and satellite nodules were independent risk factors for M2. CONCLUSIONS MiVI-TTG has a greater prognostic value than the two-tiered MiVI grading scheme in patients undergoing hepatic resection for cHCC.
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Affiliation(s)
- Yijun Wu
- Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Hongzhi Liu
- Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Yifan Chen
- Shengli Clinical Medical College of Fujian Medical University
| | - Jianxing Zeng
- Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Qizhen Huang
- Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Jinyu Zhang
- Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Yongyi Zeng
- Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Jingfeng Liu
- Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou, Fujian, People's Republic of China
- The Big Data Institute of Southeast Hepatobiliary Health Information, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, People's Republic of China
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Cao L, Wang Q, Hong J, Han Y, Zhang W, Zhong X, Che Y, Ma Y, Du K, Wu D, Pang T, Wu J, Liang K. MVI-TR: A Transformer-Based Deep Learning Model with Contrast-Enhanced CT for Preoperative Prediction of Microvascular Invasion in Hepatocellular Carcinoma. Cancers (Basel) 2023; 15:cancers15051538. [PMID: 36900327 PMCID: PMC10001339 DOI: 10.3390/cancers15051538] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/21/2023] [Accepted: 02/24/2023] [Indexed: 03/05/2023] Open
Abstract
In this study, we considered preoperative prediction of microvascular invasion (MVI) status with deep learning (DL) models for patients with early-stage hepatocellular carcinoma (HCC) (tumor size ≤ 5 cm). Two types of DL models based only on venous phase (VP) of contrast-enhanced computed tomography (CECT) were constructed and validated. From our hospital (First Affiliated Hospital of Zhejiang University, Zhejiang, P.R. China), 559 patients, who had histopathological confirmed MVI status, participated in this study. All preoperative CECT were collected, and the patients were randomly divided into training and validation cohorts at a ratio of 4:1. We proposed a novel transformer-based end-to-end DL model, named MVI-TR, which is a supervised learning method. MVI-TR can capture features automatically from radiomics and perform MVI preoperative assessments. In addition, a popular self-supervised learning method, the contrastive learning model, and the widely used residual networks (ResNets family) were constructed for fair comparisons. With an accuracy of 99.1%, a precision of 99.3%, an area under the curve (AUC) of 0.98, a recalling rate of 98.8%, and an F1-score of 99.1% in the training cohort, MVI-TR achieved superior outcomes. Additionally, the validation cohort's MVI status prediction had the best accuracy (97.2%), precision (97.3%), AUC (0.935), recalling rate (93.1%), and F1-score (95.2%). MVI-TR outperformed other models for predicting MVI status, and showed great preoperative predictive value for early-stage HCC patients.
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Affiliation(s)
- Linping Cao
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
- Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou 310003, China
| | - Qing Wang
- School of Mathematical Sciences, Zhejiang University, Hangzhou 310058, China
| | - Jiawei Hong
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
- Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou 310003, China
| | - Yuzhe Han
- School of Mathematical Sciences, Zhejiang University, Hangzhou 310058, China
| | - Weichen Zhang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
- Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou 310003, China
| | - Xun Zhong
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
- Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou 310003, China
| | - Yongqian Che
- School of Mathematical Sciences, Zhejiang University, Hangzhou 310058, China
| | - Yaqi Ma
- Department of Pathology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Keyi Du
- Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou 310003, China
| | - Dongyan Wu
- Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou 310003, China
| | - Tianxiao Pang
- School of Mathematical Sciences, Zhejiang University, Hangzhou 310058, China
| | - Jian Wu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
- Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou 310003, China
- Correspondence: (J.W.); (K.L.)
| | - Kewei Liang
- School of Mathematical Sciences, Zhejiang University, Hangzhou 310058, China
- Correspondence: (J.W.); (K.L.)
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Wang T, Li Z, Yu H, Duan C, Feng W, Chang L, Yu J, Liu F, Gao J, Zang Y, Luo Z, Liu H, Zhang Y, Zhou X. Prediction of microvascular invasion in hepatocellular carcinoma based on preoperative Gd-EOB-DTPA-enhanced MRI: Comparison of predictive performance among 2D, 2D-expansion and 3D deep learning models. Front Oncol 2023; 13:987781. [PMID: 36816963 PMCID: PMC9936232 DOI: 10.3389/fonc.2023.987781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 01/20/2023] [Indexed: 02/05/2023] Open
Abstract
Purpose To evaluate and compare the predictive performance of different deep learning models using gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI in predicting microvascular invasion (MVI) in hepatocellular carcinoma. Methods The data of 233 patients with pathologically confirmed hepatocellular carcinoma (HCC) treated at our hospital from June 2016 to June 2021 were retrospectively analyzed. Three deep learning models were constructed based on three different delineate methods of the region of interest (ROI) using the Darwin Scientific Research Platform (Beijing Yizhun Intelligent Technology Co., Ltd., China). Manual segmentation of ROI was performed on the T1-weighted axial Hepatobiliary phase images. According to the ratio of 7:3, the samples were divided into a training set (N=163) and a validation set (N=70). The receiver operating characteristic (ROC) curve was used to evaluate the predictive performance of three models, and their sensitivity, specificity and accuracy were assessed. Results Among 233 HCC patients, 109 were pathologically MVI positive, including 91 men and 18 women, with an average age of 58.20 ± 10.17 years; 124 patients were MVI negative, including 93 men and 31 women, with an average age of 58.26 ± 10.20 years. Among three deep learning models, 2D-expansion-DL model and 3D-DL model showed relatively good performance, the AUC value were 0.70 (P=0.003) (95% CI 0.57-0.82) and 0.72 (P<0.001) (95% CI 0.60-0.84), respectively. In the 2D-expansion-DL model, the accuracy, sensitivity and specificity were 0.7143, 0.739 and 0.688. In the 3D-DL model, the accuracy, sensitivity and specificity were 0.6714, 0.800 and 0.575, respectively. Compared with the 3D-DL model (based on 3D-ResNet), the 2D-DL model is smaller in scale and runs faster. The frames per second (FPS) for the 2D-DL model is 244.7566, which is much larger than that of the 3D-DL model (73.3374). Conclusion The deep learning model based on Gd-EOB-DTPA-enhanced MRI could preoperatively evaluate MVI in HCC. Considering that the predictive performance of 2D-expansion-DL model was almost the same as the 3D-DL model and the former was relatively easy to implement, we prefer the 2D-expansion-DL model in practical research.
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Affiliation(s)
- Tao Wang
- Department of Radiology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Zhen Li
- School of Medical Imaging, Weifang Medical University, Weifang, Shandong, China
| | - Haiyang Yu
- Department of Radiology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Chongfeng Duan
- Department of Radiology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Weihua Feng
- Department of Radiology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | | | - Jing Yu
- Yizhun Medical AI Co., Ltd, Beijing, China
| | - Fang Liu
- Department of Radiology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Juan Gao
- Department of Cardiology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yichen Zang
- Department of Ultrasound, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Ziwei Luo
- Department of Radiology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Hao Liu
- Yizhun Medical AI Co., Ltd, Beijing, China
| | - Yu Zhang
- Department of Radiology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xiaoming Zhou
- Department of Radiology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China,*Correspondence: Xiaoming Zhou,
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Liang G, Yu W, Liu S, Zhang M, Xie M, Liu M, Liu W. The diagnostic performance of radiomics-based MRI in predicting microvascular invasion in hepatocellular carcinoma: A meta-analysis. Front Oncol 2023; 12:960944. [PMID: 36798691 PMCID: PMC9928182 DOI: 10.3389/fonc.2022.960944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 12/23/2022] [Indexed: 02/01/2023] Open
Abstract
Objective The aim of this study was to assess the diagnostic performance of radiomics-based MRI in predicting microvascular invasion (MVI) in hepatocellular carcinoma (HCC). Method The databases of PubMed, Cochrane library, Embase, Web of Science, Ovid MEDLINE, Springer, and Science Direct were searched for original studies from their inception to 20 August 2022. The quality of each study included was assessed according to the Quality Assessment of Diagnostic Accuracy Studies 2 and the radiomics quality score. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were calculated. The summary receiver operating characteristic (SROC) curve was plotted and the area under the curve (AUC) was calculated to evaluate the diagnostic accuracy. Sensitivity analysis and subgroup analysis were performed to explore the source of the heterogeneity. Deeks' test was used to assess publication bias. Results A total of 15 studies involving 981 patients were included. The pooled sensitivity, specificity, PLR, NLR, DOR, and AUC were 0.79 (95%CI: 0.72-0.85), 0.81 (95%CI: 0.73-0.87), 4.1 (95%CI:2.9-5.9), 0.26 (95%CI: 0.19-0.35), 16 (95%CI: 9-28), and 0.87 (95%CI: 0.84-0.89), respectively. The results showed great heterogeneity among the included studies. Sensitivity analysis indicated that the results of this study were statistically reliable. The results of subgroup analysis showed that hepatocyte-specific contrast media (HSCM) had equivalent sensitivity and equivalent specificity compared to the other set. The least absolute shrinkage and selection operator method had high sensitivity and specificity than other methods, respectively. The investigated area of the region of interest had high specificity compared to the volume of interest. The imaging-to-surgery interval of 15 days had higher sensitivity and slightly low specificity than the others. Deeks' test indicates that there was no publication bias (P=0.71). Conclusion Radiomics-based MRI has high accuracy in predicting MVI in HCC, and it can be considered as a non-invasive method for assessing MVI in HCC.
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Affiliation(s)
- Gao Liang
- Department of Radiology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Wei Yu
- Department of Radiology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Shuqin Liu
- Department of Radiology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Mingxing Zhang
- Department of Radiology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Mingguo Xie
- Department of Radiology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China,*Correspondence: Mingguo Xie,
| | - Min Liu
- Toxicology Department, West China-Frontier PharmaTech Co., Ltd. (WCFP), Chengdu, Sichuan, China
| | - Wenbin Liu
- Department of Radiology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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Huang SS, Zuo MX, Xie CM. Combining Preoperative Clinical and Imaging Characteristics to Predict MVI in Hepatitis B Virus-Related Combined Hepatocellular Carcinoma and Cholangiocarcinoma. J Pers Med 2023; 13. [PMID: 36836479 DOI: 10.3390/jpm13020246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/23/2023] [Accepted: 01/28/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Combined hepatocellular carcinoma and cholangiocarcinoma (cHCC-CCA) is a rare form of primary liver malignancy. Microvascular invasion (MVI) indicates poor postsurgical prognosis in cHCC-CCA. The objective of this study was to investigate preoperative predictors of MVI in hepatitis B virus (HBV) -related cHCC-CCA patients. METHODS A total of 69 HBV-infected patients with pathologically confirmed cHCC-CCA who underwent hepatectomy were included. Univariate and multivariate analyses were conducted to determine independent risk factors that were then incorporated into the predictive model associated with MVI. Receiver operating characteristic analysis was used to assess the predictive performance of the new model. RESULTS For the multivariate analysis, γ-glutamyl transpeptidase (OR, 3.69; p = 0.034), multiple nodules (OR, 4.41; p = 0.042) and peritumoral enhancement (OR, 6.16; p = 0.004) were independently associated with MVI. Active replication of HBV indicated by positive HBeAg showed no differences between MVI-positive and MVI-negative patients. The prediction score using the independent predictors achieved an area under the curve of 0.813 (95% CI 0.717-0.908). A significantly lower recurrence-free survival was observed in the high-risk group with a score of ≥1 (p < 0.001). CONCLUSION γ-glutamyl transpeptidase, peritumoral enhancement and multiple nodules were independent preoperative predictors of MVI in HBV-related cHCC-CCA patients. The established prediction score demonstrated satisfactory performance in predicting MVI pre-operatively and may facilitate prognostic stratification.
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Wang X, Fu Y, Zhu C, Hu X, Zou H, Sun C. New insights into a microvascular invasion prediction model in hepatocellular carcinoma: A retrospective study from the SEER database and China. Front Surg 2023; 9:1046713. [PMID: 36684226 PMCID: PMC9853393 DOI: 10.3389/fsurg.2022.1046713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 12/14/2022] [Indexed: 01/09/2023] Open
Abstract
Background and Aims The prognosis of liver cancer is strongly influenced by microvascular infiltration (MVI). Accurate preoperative MVI prediction can aid clinicians in the selection of suitable treatment options. In this study, we constructed a novel, reliable, and adaptable nomogram for predicting MVI. Methods Using the Surveillance, Epidemiology, and End Results (SEER) database, we extracted the clinical data of 1,063 patients diagnosed with hepatocellular carcinoma (HCC) and divided it into either a training (n = 739) or an internal validation cohort (n = 326). Based on multivariate analysis, the training cohort data were analyzed and a nomogram was generated for MVI prediction. This was further verified using an internal validation cohort and an external validation cohort involving 293 Chinese patients. Furthermore, to evaluate the efficacy, accuracy, and clinical use of the nomogram, we used concordance index (C-index), calibration curve, and decision curve analysis (DCA) techniques. Results In accordance with the multivariate analysis, tumor size, tumor number, alpha-fetoprotein (AFP), and histological grade were independently associated with MVI. The established model exhibited satisfactory performance in predicting MVI. The C-indices were 0.719, 0.704, and 0.718 in the training, internal validation, and external validation cohorts, respectively. The calibration curves showed an excellent consistency between the predictions and actual observations. Finally, DCA demonstrated that the newly developed nomogram had favorable clinical utility. Conclusions We established and verified a novel preoperative MVI prediction model in HCC patients. This model can be a beneficial tool for clinicians in selecting an optimal treatment plan for HCC patients.
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Affiliation(s)
- Xingchang Wang
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yiling Fu
- Department of Rehabilitation Medicine, Qilu Hospital of Shandong University (Qingdao), Qingdao, China
| | - Chengzhan Zhu
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiao Hu
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hao Zou
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China,Correspondence: Chuandong Sun Hao Zou
| | - Chuandong Sun
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China,Correspondence: Chuandong Sun Hao Zou
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Sheng H, Mao M, Huang K, Zheng H, Liu W, Liang Y. A Clinical Tool to Predict the Microvascular Invasion Risk in Patients with Hepatocellular Carcinoma. Technol Cancer Res Treat 2023; 22:15330338231182526. [PMID: 37309125 DOI: 10.1177/15330338231182526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Microvascular invasion (MVI) plays an important role in tumor progression. The aim of this study is to establish and validate an effective hematological nomogram for MVI prediction in hepatocellular carcinoma (HCC). METHODS A retrospective study was performed in a primary cohort that includes 1306 patients clinicopathologically diagnosed with HCC, and a validation cohort contained 563 continuous patients. Univariate logistic regression was used to assess the association between variables included both clinicopathologic factors and coagulation parameters (prothrombin time, activated partial thromboplastin time, fibrinogen, and thrombin time [TT]) and MVI. Multiple logistic regression was used to construct a prediction nomogram. We tested the accuracy of the nomogram by discrimination and calibration, and then plotted decision curves to assess the benefits of the nomogram-assisted decisions in a clinical context. RESULTS In the two cohorts, patients without MVI had the longest overall survival (OS), compared the OS with MVI. The multivariate analysis indicated that age, sex, tumor node metastasis (TNM) stage, aspartate aminotransferase, alpha fetoprotein, C-reactive protein, and TT were identified as significant independent predictors of MVI of HCC patients. The Hosmer-Lemeshow test showed good point estimate associated P value between predicted risk and observed risk across the deciles. Moreover, the calibration performance of the nomogram risk scores in each decile of the primary cohort was within 5 percentage points of the mean predicted risk score, and in the validation cohort, the observed risk in 90% decile was within 5 percentage points of the mean predicted risk score. CONCLUSIONS A noninvasive and easy-to-use nomogram was established and may be used to predict preoperative MVI in HCC.
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Affiliation(s)
- Hui Sheng
- Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Minjie Mao
- Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Kewei Huang
- Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Hailin Zheng
- Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Wen Liu
- Sun Yat-sen University Cancer Center, Guangzhou, China
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