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Microscopic Portal Vein Invasion in Relation to Tumor Focality and Dimension in Patients with Hepatocellular Carcinoma

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Microscopic portal vein invasion (microPVI) and tumor multifocality are hepatocellular carcinoma (HCC) prognosis factors. To investigate whether microPVI and multifocality are directly related to each other.

Methods

We retrospectively analyzed the relationships between microPVI, multifocality, and maximum tumor diameter (MTD) in prospectively collected transplanted HCC patients.

Results

HCCs with 1, 2, or ≥ 3 foci had more microPVI in larger than in smaller HCCs, with microPVI being present in 52.24% of single large foci. Conversely, microPVI patients had similar percentages of single and multifocal lesions. A linear regression model of MTD, showed microPVI best associated with MTD, with 2.49 as coefficient, whereas multifocality had a 0.83 coefficient. A logistic regression model of microPVI showed significant association with tumor multifocality, especially for small HCCs. Trends for microPVI and multifocality in relation to MTD revealed that both increased with MTD but more significantly for microPVI. Survival was similar in patients with small HCCs, with or without microPVI, but was significantly worse in microPVI patients with larger HCCs. No patient survival differences were found in relation to focality.

Conclusions

MTD had stronger associations with microPVI than with multifocality. microPVI was associated with worse survival in patients with large HCCs, but survival was not impacted by number of tumor foci. microPVI and multifocality appear weakly related, having different behavior in relation to MTD and survival.

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Abbreviations

microPVI:

Microscopic portal vein invasion

PVT:

Portal venous invasion

HCC:

Hepatocellular carcinoma

MTD:

Maximum tumor diameter

AFP:

Alpha-fetoprotein

TMB:

Tumor mutation burden

LDLT:

Liver donor liver transplant

OR:

Odds ratio

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Funding

This work was supported in part by NIH grant CA 82723 (B.I.C).

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Authors and Affiliations

  1. Department of Surgery, Faculty of Medicine, Liver Transplant Institute, Inonu University, Elazig Yolu 10. Km, 44280, Malatya, Turkey

    Brian I. Carr, Volkan Ince, Sami Akbulut, Veysel Ersan, Sertac Usta, Burak Isik & Sezai Yilmaz

  2. National Institute of Digestive Diseases. IRCCS S. de Bellis Research Hospital, Castellana Grotte, Italy

    Vito Guerra & Rossella Donghia

  3. Department of Pathology, Faculty of Medicine, Inonu University, 44280, Malatya, Turkey

    Emine Samdanci

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  1. Brian I. Carr
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  2. Vito Guerra
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  3. Rossella Donghia
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  4. Volkan Ince
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  5. Sami Akbulut
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  8. Burak Isik
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  10. Sezai Yilmaz
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Contributions

BIC—concept, ideas, and writing. VG and RD—biostatistics. VI, SA, VE, SU, IB, and SY—data collection and paper proofing. ES—pathology analysis.

Corresponding author

Correspondence to Sami Akbulut.

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Institutional review board statement

This work complies with the guidelines of the World Medical Association, Declaration of Helsinki. This study was reviewed and approved by the Inonu University Institutional Review Board for non-interventional studies (Approval no: 2018/1–9).

Informed Consent Statement

Verbal and written consents were obtained from all liver transplant patents before surgery.

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The authors declare no competing interests.

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Carr, B.I., Guerra, V., Donghia, R. et al. Microscopic Portal Vein Invasion in Relation to Tumor Focality and Dimension in Patients with Hepatocellular Carcinoma. J Gastrointest Surg 26, 333–340 (2022). https://doi.org/10.1007/s11605-021-05126-7

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  • DOI: https://doi.org/10.1007/s11605-021-05126-7

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