Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
Department of Radiology, Chengdu First People's Hospital, Chengdu, 610041, Sichuan, China.
Abdom Radiol (NY). 2019 Sep;44(9):3049-3057. doi: 10.1007/s00261-019-02126-9.
Microvascular invasion (MVI), which is difficult to diagnose before surgery, is a major factor affecting postoperative recurrence in patients with hepatocellular carcinoma (HCC). The relationship between the radiological tumor capsule and MVI is controversial. This study aimed to evaluate the association between the tumor capsule and MVI.
We searched Medline (by PubMed) and Embase (by OvidSP). Two review authors independently screened titles and abstracts, selected studies about MVI prediction with radiologic tumor capsule and studies with enough data for extracted, assessed the methodological quality and collected data. Summary results were presented as the diagnostic odds ratio (DOR), sensitivity, specificity, and 95% confidence interval.
Fifteen studies with 2038 patients were included; fourteen studies, including 1331 patients, with no significant heterogeneity indicated no relationship between absent tumor capsule and MVI [DOR = 0.90 (0.64, 1.26)]. Six studies, including 541 patients, with no significant heterogeneity showed incomplete capsule could be used to predict MVI of HCC preoperatively [DOR = 1.85 (1.13, 3.04)]. The overall sensitivity and specificity estimate were 0.50 (0.37, 0.64) and 0.64 (0.53, 0.74), respectively. Eight studies, including 1349 patients, with highly significant heterogeneity revealed that complete capsule could be a protective factor for MVI [DOR = 1.97 (1.01, 3.86)].
For MVI of HCC, incomplete tumor capsule is a risk factor, while a complete tumor capsule might be a protective factor. However, absent capsule doesn't show significant relationship with MVI. This might be due to combination of the risk and protective effects of present capsule in MVI.
微血管侵犯（MVI）在术前难以诊断，是影响肝细胞癌（HCC）患者术后复发的主要因素。肿瘤包膜与 MVI 之间的关系存在争议。本研究旨在评估肿瘤包膜与 MVI 之间的关系。
我们检索了 Medline（通过 PubMed）和 Embase（通过 OvidSP）。两名综述作者独立筛选标题和摘要，选择关于 MVI 预测的影像学肿瘤包膜的研究和有足够数据提取的研究，评估方法学质量并收集数据。总结结果以诊断优势比（DOR）、敏感性、特异性和 95%置信区间表示。
纳入了 15 项研究，共 2038 例患者；其中 14 项研究，包括 1331 例患者，无显著异质性，表明无肿瘤包膜与 MVI 之间无关系[DOR=0.90（0.64，1.26）]。6 项研究，包括 541 例患者，无显著异质性表明不完整的包膜可用于预测 HCC 术前的 MVI[DOR=1.85（1.13，3.04）]。总体敏感性和特异性估计值分别为 0.50（0.37，0.64）和 0.64（0.53，0.74）。8 项研究，包括 1349 例患者，具有高度显著的异质性，表明完整的包膜可能是 MVI 的保护因素[DOR=1.97（1.01，3.86）]。
对于 HCC 的 MVI，不完整的肿瘤包膜是一个危险因素，而完整的肿瘤包膜可能是一个保护因素。然而，不存在包膜与 MVI 之间没有显著关系。这可能是由于包膜在 MVI 中的风险和保护作用的结合。
