Microvascular Invasion in Hepatocellular Carcinoma: Some Puzzling Facets

Area of Science:

• Hepatology
• Oncology
• Transplantation Medicine

Background:

• Hepatocellular carcinoma (HCC) is the most common primary liver cancer.
• Macroscopic vascular invasion is typically seen on imaging, while microvascular invasion requires histopathological assessment.
• Understanding microvascular invasion is key to HCC prognosis and treatment planning.

Purpose of the Study:

• To determine the association between microvascular invasion and tumor aggressiveness markers in HCC.
• To evaluate the prognostic significance of microvascular invasion in HCC patients undergoing liver transplantation.

Main Methods:

• Retrospective analysis of prospectively collected data from a single center.
• Inclusion of patients who underwent liver transplantation for HCC.
• Collection of data on sociodemographics, transplant selection criteria, alpha-fetoprotein, microvascular invasion, recurrence, and survival outcomes.

Main Results:

• No significant differences in sociodemographic or radiologic characteristics were observed between patients with and without microvascular invasion.
• Microvascular invasion correlated with increased recurrence and decreased disease-free and overall survival specifically in HCC patients exceeding Milan criteria.
• For patients outside Milan criteria, microvascular invasion was a significant predictor of recurrence and reduced survival post-transplant.

Conclusions:

• Microvascular invasion is a critical prognostic factor for HCC patients undergoing liver transplantation, particularly those beyond Milan criteria.
• The presence of microvascular invasion significantly impacts recurrence rates and survival outcomes in this specific patient subgroup.
• These findings highlight the importance of assessing microvascular invasion for risk stratification and personalized treatment strategies in advanced HCC.