Introduction Microvascular invasion (MVI) is one of the most important prognostic factors for hepatocellular carcinoma (HCC) recurrence, but its application in preoperative clinical decisions is limited. This study aimed to identify preoperative predictive factors for MVI in HCC and further evaluate oncologic outcomes of different types and extents of hepatectomy according to stratified risk of MVI. Methods Patients with surgically resected single HCC (≤5 cm) who underwent preoperative gadoxetic acid-enhanced magnetic resonance imaging (MRI) were included in a single-center retrospective study. Two radiologists reviewed the images with no clinical, pathological, or prognostic information. Significant predictive factors for MVI were identified using logistic regression analysis against pathologic MVI and used to stratify patients. In the subgroup analysis, long-term outcomes of the stratified patients were analyzed using the Kaplan-Meier method with log-rank test and compared between anatomical and nonanatomical or major and minor resection. Results A total of 408 patients, 318 men and 90 women, with a mean age of 56.7 years were included. Elevated levels of tumor markers (alpha-fetoprotein [α-FP] ≥25 ng/mL and PIVKA-II ≥40 mAU/mL) and three MRI features (tumor size ≥3 cm, non-smooth tumor margin, and arterial peritumoral enhancement) were independent predictive factors for MVI. As the MVI risk increased from low (no predictive factor) and intermediate (1-2 factors) to high-risk (3-4 factors), recurrence-free and overall survival of each group significantly decreased (p = 0.001). In the high MVI risk group, 5-year cumulative recurrence rate was significantly lower in patients who underwent major compared to minor hepatectomy (26.6 vs. 59.8%, p = 0.027). Conclusion Tumor markers and MRI features can predict the risk of MVI and prognosis after hepatectomy. Patients with high MVI risk had the worst prognosis among the three groups, and major hepatectomy improved long-term outcomes in these high-risk patients.

中文翻译：

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单发性肝细胞癌患者术前用钆塞酸增强磁共振成像预测微血管侵犯：手术决策对肝切除范围的影响。


简介 微血管侵犯（MVI）是肝细胞癌（HCC）复发最重要的预后因素之一，但其在术前临床决策中的应用有限。本研究旨在确定 HCC 中 MVI 的术前预测因素，并根据 MVI 分层风险进一步评估不同类型和范围的肝切除术的肿瘤结局。方法将术前接受钆塞酸增强磁共振成像（MRI）的手术切除的单发HCC（≤5 cm）患者纳入单中心回顾性研究。两名放射科医生检查了没有临床、病理或预后信息的图像。使用针对病理 MVI 的逻辑回归分析确定了 MVI 的显着预测因素，并用于对患者进行分层。在亚组分析中，使用Kaplan-Meier方法和对数秩检验对分层患者的长期结果进行分析，并在解剖性和非解剖性或大切除和小切除之间进行比较。结果共纳入患者408例，其中男318例，女90例，平均年龄56.7岁。肿瘤标志物水平升高（甲胎蛋白 [α-FP] ≥25 ng/mL 和 PIVKA-II ≥40 mAU/mL）和 3 项 MRI 特征（肿瘤大小 ≥3 cm、肿瘤边缘不光滑和肿瘤周围动脉强化） ) 是 MVI 的独立预测因素。随着 MVI 风险从低风险（无预测因素）和中风险（1-2 个因素）增加到高风险（3-4 个因素），每组的无复发生存率和总生存率显着下降（p = 0.001）。在高 MVI 风险组中，接受大面积肝切除术的患者的 5 年累积复发率显着低于小规模肝切除术的患者（26.6% vs. 59.8%，p = 0.027）。 结论 肿瘤标志物和MRI特征可以预测肝切除术后MVI的风险和预后。 MVI 高风险患者的预后在三组中最差，而主要肝切除术改善了这些高风险患者的长期预后。