Lin En, Zou Baojia, Zeng Guifang, Cai Chaonong, Li Peiping, Chen Jiafan, Li Decheng, Zhang Baimeng, Li Jian
Department of Hepatobiliary Surgery and Liver Transplantation Center, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.
Ann Transl Med. 2021 Aug;9(16):1310. doi: 10.21037/atm-21-3731.
The pathogenesis of non-cirrhotic hepatocellular carcinoma (HCC) with a high recurrence remains controversial, while microvascular invasion (MVI) is highly suggestive of tumor recurrence. This study aimed to investigate the effects of liver fibrosis on MVI and prognosis in HCC.
Based on the data of HCC in the Surveillance, Epidemiology, and End Results (SEER) database [2004-2015], multivariate logistic regression was used for correlation analysis. Survival was analyzed by Log-Rank test and Cox regression, and decision curve analysis and receiver operating characteristic curves were established to evaluate alternative diagnostic and prognostic strategies.
The study included 1,492 patients with MVI (17.8%) or without MVI (82.2%) for HCC with a solitary nodule. Liver fibrosis was significantly correlated with the occurrence of MVI, and the risk of MVI in patients with a fibrosis score F5-6 was lower than in those with a score of F0-4 (OR =0.651, 95% CI: 0.492-0.860). Combining liver fibrosis could improve the prediction performance of MVI risk models, but liver fibrosis was less associated with survival outcomes in comparison with other tumor characteristics.
Lower liver fibrosis correlated with a higher risk of MVI in HCC with a solitary nodule and was a good indicator for improving the performance of MVI risk models. However, it was not a prognostic sensitive indicator.
高复发率的非肝硬化肝细胞癌（HCC）的发病机制仍存在争议，而微血管侵犯（MVI）高度提示肿瘤复发。本研究旨在探讨肝纤维化对HCC中MVI及预后的影响。
基于监测、流行病学和最终结果（SEER）数据库[2004 - 2015年]中HCC的数据，采用多因素逻辑回归进行相关性分析。通过对数秩检验和Cox回归分析生存率，并建立决策曲线分析和受试者工作特征曲线以评估替代诊断和预后策略。
该研究纳入了1492例孤立结节性HCC患者，其中有MVI者（17.8%）或无MVI者（82.2%）。肝纤维化与MVI的发生显著相关，纤维化评分F5 - 6的患者发生MVI的风险低于评分F0 - 4的患者（OR = 0.651，95%CI：0.492 - 0.860）。结合肝纤维化可提高MVI风险模型的预测性能，但与其他肿瘤特征相比，肝纤维化与生存结局的相关性较小。
在孤立结节性HCC中，较低的肝纤维化与较高的MVI风险相关，是改善MVI风险模型性能的良好指标。然而，它不是一个预后敏感指标。
