Prognostic Value of Microvascular Invasion in Eight Existing Staging Systems for Hepatocellular Carcinoma: A Bi-Centeric Retrospective Cohort Study.
Prognostic Value of Microvascular Invasion in Eight Existing Staging Systems for Hepatocellular Carcinoma: A Bi-Centeric Retrospective Cohort Study.
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八种现有肝细胞癌分期系统中微血管侵犯的预后价值：双中心回顾性队列研究。
DOI：
10.3389/fonc.2021.726569
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发表时间：
2021
影响因子：
4.7
通讯作者：
Cheng SQ
中科院分区：
文献类型：
--
作者：
Xiang YJ;Wang K;Zheng YT;Yu HM;Cheng YQ;Wang WJ;Shan YF;Cheng SQ
背景：微血管浸润（MVI）是影响肝细胞癌（HCC）R 0肝切除术（LR）后患者生存结局的重要危险因素。然而，现有的肝癌分期系统是否能够区分MVI患者的预后以及MVI在不同亚型肝癌中的预后价值仍有待澄清。方法2014年至2016年期间，1,198例接受R 0 LR的HCC患者的双中心回顾性数据集被纳入研究。收集基线特征和分期信息。比较了各系统的均匀性和修正的Akaike信息标准（AICc）。并分析MVI对各亚组总生存期（OS）的预后意义。结果在整个队列中，肝癌意大利计划（CLIP）评分2和3（p = 0.441）之间以及台北综合评分系统（TIS）评分3和4（p = 0.135）之间的生存率无显著差异。在MVI队列中，巴塞罗那诊所肝癌B期和C期之间没有显著的生存差异（p=0.161），CLIP评分2和3（p = 0.083），TIS评分为0和1（p = 0.227），TIS评分2和3（p =0.794），东京评分3和4（p=0.353），以及美国癌症肿瘤-淋巴结-转移联合委员会第7期I和II（p=0.151）。在8种常用的HCC分期系统中，香港肝癌（HKLC）分期系统在整个队列和MVI队列中均显示出最高的同质性和最低的AICc值。在每个分期系统的亚组中，MVI通常表现出较差的生存结局。结论在8种分期系统中，HKLC分期系统是判断MVI患者预后最准确的模型。同时，我们的研究结果表明，MVI可能需要纳入目前的HCC分期系统作为分级标准之一。
Background Microvascular invasion (MVI) is a significant risk factor affecting survival outcomes of patients after R0 liver resection (LR) for hepatocellular carcinoma (HCC). However, whether the existing staging systems of hepatocellular carcinoma can distinguish the prognosis of patients with MVI and the prognostic value of MVI in different subtypes of hepatocellular carcinoma remains to be clarified. Methods A dual-center retrospective data set of 1,198 HCC patients who underwent R0 LR was included in the study between 2014 and 2016. Baseline characteristics and staging information were collected. Homogeneity and modified Akaike information criterion (AICc) were compared between each system. And the prognostic significance of MVI for overall survival (OS) was studied in each subgroup. Results In the entire cohort, there were no significant survival differences between Cancer of the Liver Italian Program (CLIP) score 2 and 3 (p = 0.441), and between Taipei Integrated Scoring System (TIS) score 3 and 4 (p = 0.135). In the MVI cohort, there were no significant survival differences between Barcelona Clinic Liver Cancer stages B and C (p=0.161), CLIP scores 2 and 3 (p = 0.083), TIS scores 0 and 1 (p = 0.227), TIS scores 2 and 3 (p =0.794), Tokyo scores 3 and 4 (p=0.353), and American Joint Committee on Cancer Tumor-Node-Metastasis 7th stage I and II (p=0.151). Among the eight commonly used HCC staging systems, the Hong Kong Liver Cancer (HKLC) staging system showed the highest homogeneity and the lowest AICc value in both the entire cohort and MVI cohort. In each subgroup of the staging systems, MVI generally exhibited poor survival outcomes. Conclusions The HKLC staging system was the most accurate model for discriminating the prognosis of MVI patients, among the eight staging systems. Meanwhile, our findings suggest that MVI may be needed to be incorporated into the current HCC staging systems as one of the grading criteria.
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