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Objective: To explore the application value of magnetic resonance imaging (MRI) multi-sequence scan in the diagnosis of hepatocellular carcinoma (HCC) and evaluation of microvascular invasion (MVI). Methods: A retrospective collection was performed on the clinical data of 100 patients with suspected HCC in the hospital between October 2019 and October 2022. All completed MRI multi-sequence scan and pathological examination. Taking pathological examination as the golden standard, the consistency between MRI multi-sequence scan and pathological examination in the diagnosis of HCC and evaluation of MVI was analyzed by Kappa test. Results: Among the 100 patients, pathological examination showed that there were 51 cases (51.00%) with HCC and 49 cases (49.00%) with benign liver lesions. In the 51 HCC patients, there were 17 cases (33.33%) with MVI. Taking pathological examination as the golden standard, sensitivity, specificity and Kappa values of T2WI in the diagnosis of HCC and MVI were (82.35%, 79.59%, 0.620) and (64.71%, 85.29%, 0.507), respectively. The sensitivity, specificity and Kappa values of TIWI in the diagnosis of HCC and MVI were (76.47%, 81.63%, 0.580) and (58.82%, 88.24%, 0.492), respectively. The sensitivity, specificity and Kappa values of LAVA in the diagnosis of HCC and MVI were (84.31%, 83.67%, 0.580) and (64.71%, 91.18%, 0.585), respectively. The sensitivity, specificity and Kappa values of MRI multi-sequence scan in the diagnosis of HCC and MVI were (96.08%, 79.59%, 0.759) and (94.12%, 82.35%, 0.712), respectively. The sensitivity of MRI multi-sequence scan was higher than that of single sequence (P<0.05). The proportions of unsmooth tumor edge and peritumoral enhancement in patients with MVI positive were higher than those with MVI negative (P<0.05). Conclusion: MRI multi-sequence scan is conductive to clinical diagnosis of HCC and evaluation of MVI. Unsmooth tumor edge and peritumoral enhancement have predictive significance in HCC and MVI. [ABSTRACT FROM AUTHOR]

Objective To investigate the efficacy and safety of drug-eluting bead transarterial chemoembolization (DEB- TACE) as neoadjuvant therapy before liver transplantation (LT) in patients with hepatocellular carcinoma (HCC) beyond Milan criteria with microvascular invasion (MVI) and its impact on the prognosis after LT. Methods From May 2016 to December 2022, 141 patients with HCC beyond Milan criteria underwent LT. A total of 55 patients with MVI were enrolled in the study and were divided into DEB-TACE before LT group (n=26) and control group (n=29) that did not receive any treatment before LT. The Kaplan-Meier method was utilized to estimate the overall survival (OS) rate and recurrence-free survival (RFS) rate after LT after potential prognostic factors for RFS and OS were identified. Results The objective response rate after DEB-TACE was 88%, and the main adverse event was embolization syndrome. The 1-, 2- and 3-year RFS rates in DEB-TACE group (88.5%, 79.2% and 73.9%) were higher than control group (69%, 50% and 44.4%). The 3-year RFS rate was significantly different between the two groups (χ²= 4.428, P=0.035). The 1-, 2- and 3-year OS rates in DEB-TACE group (100%, 91.7% and 82.6%) were not significantly (χ²=3.224, P=0.073) higher than control group (96.6%, 82.1% and 59.3%). Conclusion Preoperative DEB-TACE neoadjuvant therapy can improve the prognosis of LT in patients with HCC beyond Milan criteria with MVI. [ABSTRACT FROM AUTHOR]

Objective: To analyze the predictive value of contrast-enhanced ultrasound (CEUS) combined with serum alpha-fetoprotein (AFP), γ-glutamyl transpeptidase (GGT) and lymphocyte count ratio (GLR) for microvascular invasion (MVI) of hepatocellular carcinoma (HCC). Methods: 177 HCC patients who underwent hepatectomy in The 73rd Group Army Hospital of the Chinese People's Liberation Army from October 2018 to October 2023 were selected, all patients underwent CEUS and serum AFP, GGT and GLR examinations 1 week before operation. According to the results of postoperative pathological examination of MVI, patients were divided into MVI positive group (n=52) and MVI negative group (n=125). The risk factors affecting MVI in HCC patients were analyzed by multivariate Logistic regression analysis, the predictive value of CEUS combine with AFP, GGT and GLR for MVI in HCC patients were analyzed by receiver operating characteristic (ROC) curve. Results: The onset time, peak time and clearance time in MVI positive group were shorter than those in MVI negative group (P<0.05). AFP, GGT and GLR in MVI positive group were significantly higher than those in MVI negative group(P<0.05). Multivariate Logistic regression analysis showed that elevated AFP, elevated GGT, elevated GLR, irregular lesion morphology, shortened onset time, shortened peak time, and shortened clearance time were independent risk factors for MVI in HCC patients (P<0.001). The ROC results showed that, the area under the curve of MVI in HCC patients predicted by the combination of serum AFP, GGT and GLR was 0.901, which was significantly larger than that of single detection(P<0.05). Conclusion: The levels of serum AFP, GGT and GLR in patients with MVI after HCC operation increased, and the time of initial increase, peak time and clearance time were shortened, which were independent risk factors for MVI in HCC patients. CEUS combined with AFP, GGT and GLR has a high predictive value for MVI in HCC patients. [ABSTRACT FROM AUTHOR]

Objective: To observe the effects of carrelizumab combined with transcatheter arterial chemoembolization (TACE) on tumor markers, angiogenic factors, serum programmed cell death protein-1 (PD-1) and programmed death ligand-1 (PD-L1) in patients with hepatocellular carcinoma (HCC) with microvascular invasion. Methods: 121 HCC patients with microvascular invasion who were admitted to our hospital from June 2021 to July 2023 were divided into control group (n=60, receiving radical resection of liver cancer and TACE treatment) and study group (n=61, receiving carrelizumab treatment on the basis of control group) according to the random number table method. The efficacy, serum tumor marker levels [alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), abnormal prothrombin (PIVKA-II), carbohydrate antigen 199 (CA199)], angiogenesis factor levels [vascular endothelial growth factor receptor 2 (VEGF-R2), angiopoietin-2 (Ang-2), vascular endothelial growth factor (VEGF)], serum PD-1 and PD-L1 levels, adverse reactions were compared between two groups (P>0.05). Results: Compared with control group, the total clinical effective rate in study group was higher (P<0.05). Compared with control group after treatment, CEA, AFP, CA199, PIVKA-II, VEGF, VEGF-R2, Ang-2, PD-1 and PD-L1 in study group were lower(P<0.05). There was no difference in the incidence of adverse reactions between two groups(P>0.05). Conclusion: Carrelizumab combined with TACE in the treatment of HCC patients with microvascular invasion, which can improve the serum tumor markers, inhibit angiogenesis and reduce serum PD-1 and PD-L1 levels, and effectively control disease progression. [ABSTRACT FROM AUTHOR]

Background Microvascular invasion (MVI) is an aggressive behavior of hepatocellular carcinoma (HCC) that being an independent predictor of tumor recurrence after hepatectomy or liver transplantation. Preoperative prediction of MVI has important clinical significance. Objective To use non-invasive imaging and serological indicators to construct a nomogram for predicting MVI in order to provide a clinical reference. Methods The relevant clinical data of 284 patients who underwent radical resection of HCC in the Second Affiliated Hospital of Kunming Medical University from 2016 to 2021 were retrospectively analyzed, and HCC patients admitted from 2016 to 2020 were categorized as the model group (n=208) according to the admission time, and HCC patients admitted in 2021 were categorized as the validation group (n=76) . LASSO regression and multivariate Logistic regression analysis were performed to determine the independent risk factors for MVI in HCC, and R software was used to establish a nomogram model for predicting the risk of MVI in HCC before operation. The internal validation of the model was performed by Bootstrap method, external validation of the model was performed by using the validation group. The consistency index, calibration curve and decision curve analysis (DCA) were used to evaluate the discrimination, calibration ability and clinical application value of the nomogram. Results Multivariate Logistic regression analysis showed that WBC>7.1×109/L〔OR=3.144, 95%CI (1.301, 7.598) , P=0.011〕, tumor diameter>7.05 cm〔OR=3.836, 95%CI (1.758, 8.372) , P=0.001〕, S-Index>0.097〔OR=3.165, 95%CI (1.024, 9.779) , P=0.040〕, AAR>0.879〔OR=2.146, 95%CI (1.062, 4.337) , P=0.030〕, ANRI>24.074〔OR=2.769, 95%CI (1.175, 6.526) , P=0.020〕 were independent predictors of MVI in HCC. The consistency index of the nomogram model established using the five variables combined with AFP was 0.800〔95%CI (0.739, 0.861) 〕 and 0.755〔95%CI (0.641, 0.868) 〕 in the model group and validation group, respectively. The model fitted well with the calibration prediction curve. The optimal critical value of the nomogram calculated by Youden index was 174 points. The sensitivity, specificity, positive predictive value and negative predictive value at the critical value were 90%, 61%, 71%, and 85% in the model group, and 78%, 71%, 76% and 74% in the validation set, respectively. Conclusion The nomogram constructed with AFP>45 ng/mL, WBC>7.1×109/L, tumor diameter>7.05 cm, S-Index>0.097, AAR>0.879, ANRI>24.074 can better predict the risk of preoperative MVI in HCC, the use of this nomogram can conveniently guide the clinical treatment of HCC patients by routine examination test indicators.

Copyright of Journal of China Medical University is the property of Journal of China Medical University Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective To investigate the risk factors of microvascular invasion (MVI) in China liver cancer staging system stage Ⅰa (CNLC Ⅰa) hepatocellular carcinoma (HCC), and develop a nomogram for predicting MVI based on clinical and radiographic data. Methods This retrospective study focused on CNLC Ⅰa HCC patients who underwent radical resection at the Cancer Hospital, Chinese Academy of Medical Sciences from January 2016 to December 2020. Patients′ clinical characteristics and laboratory test results and pre-surgery gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging results were collected. The clinical and radiographic risk factors for MVI were identified by univariate and multivariate logistic regression analyses and used for the construction of the predictive nomogram. The nomogram model was then internally validated, and its performance was assessed. Results A total of 104 patients were divided into the MVI-positive group (n=28) and the MVI-negative group (n=76). Multivariate logistic regression analysis at the P<0.1 level identified serum alpha-ferroprotein >7 ng/ml, total bilirubin >21 μmol/L, prothrombin time >12.5 s, non-smooth margin, and incomplete or absent capsule as risk factors of MVI, based on which a nomogram model was built. The model achieved an area under the curve (AUC) value of 0.867 (95% confidence interval, 0.791-0.944) in the internal validation. The sensitivity and specificity of the nomogram model were 0.786 and 0.829, respectively, with the prediction curve nearly overlapping the ideal curve. Based on the Hosmer-Leme show test, the predicted and real results were not significantly different (P=0.956). Conclusions The probability of MVI of CNLC Ⅰa HCC can be objectively predicted by the monogram model that quantifies the clinical and radiographic risk factors. The model can also help clinicians select individualized surgical plans to improve the long-term prognosis of patients. [ABSTRACT FROM AUTHOR]

Objective：The current study aims to establish a risk model for microvascular invasion (MVI) in patients with hepatocellular carcinoma (HCC), which is based on radiological characteristics and clinical laboratory data, and to explore the clinical application of preoperative alpha ⁃fetoprotein (AFP) and gamma ⁃glutamyl transferase (GGT) in HCC patients. Methods：Clinical data from 479 HCC patients with surgically resection at the First Affiliated Hospital of Nanjing Medical University were retrospectively collected to investigate the effects of potentially relevant factors on MVI, and to assess the benefits of serum AFP and GGT on improving model predictive performance. Univariate and multivariate logistic regression analyses were used to select variables for the final prediction model, and the predictive performance of the model was assessed by area under the receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis (DCA) . Predictive performance was compared by sensitivity, specificity and accuracy analyses. Kaplan ⁃ Meier curves were applied to assess the probability of patient survival. Results：In a multifactorial analysis, tumor size, borders of the tumor, exophytic growth, AFP and GGT were independent predictors for the development of MVI in HCC patients. Two models were constructed with or without AFP and GGT, respectively. In both cohorts, model A with AFP and GGT showed better predictive performance than model B without AFP and GGT, with AUCs of 0.902 (0.872⁃0.932) and 0.876 (0.842⁃0.909), respectively. The two models showed good discrimination, and the predicted probabilities were in good agreement with the observed probabilities. Analysis of the DCA, which assesses the net clinical benefit of the models, showed that model A was slightly better than model B, both with good clinical application. In the subgroup analysis, AFP and GGT could well predict the prognosis of HCC patients. Conclusion：A predictive model for the development of MVI in patients with HCC was developed, and the study confirmed the clinical predictive value of serum AFP and GGT. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Modern Laboratory Medicine is the property of Journal of Modern Laboratory Medicine Editorial Department and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background The microvascular invasion pathologically diagnosed in hepatocellular carcinoma (HCC) has not been valued enough in previous studies. And there are no unified pathological diagnostic criteria for microvascular invasion in HCC. Besides that, microvascular invasion is not included as a routine pathological indicator for HCC. C-reactive protein to albumin ratio (CAR) is a new systemic inflammatory factor that is closely related to the proliferation, invasion, metastasis and other malignant biological behaviors of HCC. Objective To investigate the value of CAR in predicting microvascular invasion in single small HCC. Methods Participants (n=346) who were pathologically diagnosed with HCC following the resection of single liver tumor (diameter≤5 cm) were selected from the First Affiliated Hospital of Xinjiang Medical University from June 2017 to June 2021. Demographic data and calculated CAR were collected. ROC analysis was performed to estimate the predictive value and optimal cut-off value of CAR for microvascular invasion in single small HCC. All patients were divided into two groups according to the optimal cut-off value of CAR (≥0.03 or

Objective To assess the prediction value of a nomogram model constructed by gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI signatures combined with the mean T1 relaxation time of tumor and the peritumor dual-region for microvascular invasion of hepatocellular carcinoma.Methods Seventy-two patients with solitary hepatocellular carcinoma (HCC) underwent preoperative Gd-EOB-DTPA-enhanced MRI and curative liver resection in our hospital from January 2019 to September 2022.The patients were divided to two groups with (MVI+, 23) and without (MVI-, 49) microvascular invasion (MVI).The clinical information and MRI were retrospectively analyzed.Multivariate logistic analyses were used to screen out independent risk factors that could predict MVI.Two models were constructed with (T1 model) or without (no T1 model) inclusion of T1 relaxation time and their diagnostic efficacy was evaluated using a subject operating curve, calibration curve and decision curve.Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were used to evaluate the differences between models and to select the optimal model to construct a nomogram.Results There was significant difference between the MVI-and MVI+groups in tumor margin (P＜0.001), tumor capsule (P=0.010), mosaic architecture (P=0.015), peritumoral enhancement in the arterial phase (P=0.018), peritumoral hypointensity in the hepatobiliary phase (P＜0.001), preoperative alpha-fetoprotein (P=0.003), tumor size (P＜0.001), T1 P+tumor (P=0.001), T1 E+tumor (P=0.009), T1 P+10 mm (P=0.014), T1 P+tumor+10 mm (P＜0.001), T1 E+tumor+10 mm (P=0.001), T1 P+tumor+20 mm (P=0.001), T1 E+tumor+20 mm (P=0.002) and T1D%tumor+20 mm (P=0.035).Multivariate logistic regression analysis showed that tumor margin (P=0.005;OR=10.391), peritumoral enhancement in the arterial phase (P=0.020;OR=7.729), peritumoral hypointensity in the hepatobiliary phase (P=0.003;OR=12.891) and T1 P+tumor+10 mm (P=0.026;OR=1.006)were independent risk factors for the occurrence of MVI in hepatocellular carcinoma.The areas under the ROC curves were 0.906 (0.840-0.973) for the no T1 model and 0.928 (0.873-0.984) for the T1 model.The calibration curve showed that the predicted probability was in good agreement with the MVI+/MVI-probability of the pathological results.The decision curve analysis displayed a more satisfactory net benefit rate of T1 model than that of no T1 model.The T1 model increased NRI by 0.4366 and IDI by 0.0689 compared to the no T1 model.Conclusion Gd-EOB-DTPA-enhanced MRI can be used to predict HCC MVI effectively.The combination of T1 P+tumor+10 mmin the nomogram model further improves the predictive efficacy of hepatocellular carcinoma MVI. [ABSTRACT FROM AUTHOR]

Objective To construct and validate a nomogram model for predicting microvascular invasion(MVI) based on the characteristics on contrast-enhanced ultrasound(CEUS) Liver Imaging Reporting and Data System(LI-RADS) in patients with hepatocellular carcinoma(HCC). Methods A total of 262 patients with HCC who were diagnosed in Wujin Hospital Affiliated to Jiangsu University from January 2017 to July 2020 were enrolled and randomly divided into modeling group and validation group at a ratio of 1∶1, with 131 patients in each group. MVI was confirmed by postoperative microscopic pathological results, and there were 70 patients with MVI in the modeling group and 56 patients with MVI in the validation group. CEUS was used to evaluate LI-RADS characteristics for the two groups. The independent samples t-test was used for comparison of continuous data between the two groups, and the chi-square test was used for comparison of categorical data between the two groups. Univariate and multivariate Logistic regression analyses were used to identify the risk factors for MVI in the modeling group; the receiver operating characteristic(ROC) curve was plotted, and the area under the ROC curve(AUC) was calculated for the model in predicting MVI to evaluate the accuracy of prediction; a decision curve analysis was used to evaluate the consistency of the model, and dispersion was compared between the calibration curve and the standard curve for the model in predicting MVI. Results There were no significant differences in clinical data and CEUS findings between the modeling group and the validation group(all P>0.05). The univariate analysis showed that compared with the MVI-negative patients, the MVI-positive patients had significant increases in serum alpha fetoprotein(AFP) level, tumor diameter, and LR-5 “late and mild washout” and LR-M “early washout” on LI-RADS, as well as a significantly higher LI-RADS grade(all P<0.05). The multivariate analysis showed that AFP 20-400 ng/mL(odds ratio [OR]=2.65, P<0.001), AFP≥400 ng/mL(OR=3.98, P<0.001), tumor diameter ≥30 mm(OR=2.12, P<0.001), and LR-M on CEUS(OR=3.24, P<0.001) were independent risk factors for MVI. The ROC curve analysis showed that the nomogram had an AUC of 0.867 and 0.821 in predicting MVI in the modeling group and the validation group, respectively. The nomogram model had a C-Index of 0.765(95% confidence interval: 0.701-0.834). The calibration curves of the nomogram model were close to the standard curve in both groups. Conclusion The nomogram model based on LI-RADS obtained by CEUS in combination with AFP and tumor diameter has a good application value and can guide the preoperative screening for patients at a high risk of MVI and the development of appropriate surgical plans in clinical practice. [ABSTRACT FROM AUTHOR]

Objective To investigate the diagnostic value of quantitative parameters of dual-energy CT (DECT) in the microvascular invasion of HCC. Methods Clinicopathological and imaging data of 56 patients, who underwent preoperative DECT for pathologically confirmed HCC were retrospectively analyzed. The iodine densities (ID) of solid part of the lesion, edge of the lesion, within 1 cm of the lesion edge, 1 cm outside the lesion, and abdominal aorta on the same plane in the arterial and venous phases were measured. According to Standardization for Diagnosis and Treatment of Primary Hepatic Carcinoma (2019 edition), all 56 patients were classified as 28 microvascular invasion (MVI) or 28 non-MVI. The parameters of DECT were compared between the two groups. The receiver operating characteristic (ROC) curves were drawn to evaluate the diagnostic efficacy of any statistically significant quantitative parameters in the MVI of HCC. Results There were no significant differences in the ID of outside 1 cm of the lesion in the arterial phase and solid part of the lesion, edge of the lesion, within 1 cm of the lesion in venous phase (P>0.05). There was no significant difference (P> 0.05) between the ID of solid part of the lesion in arterial phase (AUC=0.756) and outside 1 cm edge the lesion in venous phase (0.694). Combined with age, alpha-fetoprotein (AFP), and aspartate aminotransferase (AST), ID of solid part of the lesion in arterial phase and ID of outside 1 cm of the lesion in the venous phase had AUC of 0.926 with sensitivity of 82.14%, and specificity of 96.43%. Conclusion The ID of solid part of the HCC in arterial phase and ID of outside 1 cm of the lesion in the venous phase on DECT can aid preoperative evaluation of HCC microvascular invasion. [ABSTRACT FROM AUTHOR]

Objective To investigate the value of the contrast enhanced ultrasound (CEUS) combined with immunohistochemistry (IHC) in preoperative diagnosis of microvascular invasion (MVI) of small hepatocellular carcinoma (HCC). Methods The data of 142 HCC patients, including 177 newly developed HCC lesions with a maximum diameter of no more than 3 cm were retrospectively collected from the Yokohama City University Medical Center of Japan and the First Affiliated Hospital of Xi'an Jiaotong University. According to the pathological diagnosis, the patients were divided into MVI (+) group (n=37) and MVI (-) group (n=140). Preoperative CEUS arterial phase (AP) and post ⁃ vascular phase (PVP) images were used to observe whether there was hypervascularity and hypovascularity around the lesion. The expressions of heat shock protein 70 (HSP70) and glypican 3 (GPC3) in preoperative biopsy samples were detected by IHC method. Results When all CEUS indicators (AP, PVP) and IHC indicators (GPC3, HSP70) were diagnosed MVI individually, PVP had the highest diagnostic efficiency, with an accuracy of 91.0% and an area under the curve (AUC) of 0.893. The diagnostic efficiency of GPC3 combined with HSP70 (accuracy: 79.8%, AUC: 0.790) was better than that of GPC3 alone (accuracy: 69.5%, AUC: 0.752) or HSP70 alone (accuracy: 60.7%, AUC: 0.701). The combined diagnosis of PVP+GPC3+HSP70 had the best diagnostic efficiency, with a specificity of 98.5%, an accuracy of 92.5%, and an AUC of 0.840. Conclusions Observing the PVP of CEUS and using IHC to detect the expressions of GPC3 and HSP70 can better diagnose the MVI of small HCC preoperatively. [ABSTRACT FROM AUTHOR]

Objective To explore the related risk factors of microvascular invasion (MVI) in hepatocellular carcinoma (HCC), and to construct a predictive model of MVI. Methods The clinical data of 178 patients with HCC who underwent orthotopic liver transplantation for the first time were analyzed. Patients were divided into the MVI positive group (76 cases) and the MVI negative group (102 cases) according to postoperative pathological results. The preoperative general information, preoperative CT or MRI examination results, preoperative laboratory examination results, and pathological results of the patients were collected, and the patients were followed up. The recurrence-free survival (RFS) time was recorded for all patients. The diagnostic values of alpha-fetoprotein (AFP), aspartate aminotransferase to lymphocyte ratio (ALRI), tumor maximum diameter, γ-glutamyl transpeptidase to lymphocyte count ratio (GLR) and neutrophil to lymphocyte ratio (NLR) were analyzed through receiver operating characteristic (ROC) curve for the diagnosis of MVI, and the optimal cut-off value was determined. Multivariate Logistic regression was used to analyze the independent risk factors of MVI, and a predictive scoring model was established. The patients were divided into the MVI high-risk group (3-4 points, 67 cases) and the MVI low-risk group (0-2 points, 111 cases) according to the optimal cut-off value of the scoring model. The Kaplan Meier survival curve was drawn to compare the RFS rate of the two groups. Results Compared with the MVI-negative group, there were higher proportions of multiple tumors, tumor maximum diameter＞3.75 cm, preoperative AFP＞53.8 μg/L, NLR＞3, GLR＞85.84 and ALRI＞75.36 in the MVI-positive group (P＜0.05). The largest tumor diameter＞3.75 cm, preoperative AFP＞53.8 μg/L, GLR＞85.84, ALRI＞75.36 were independent risk factors for MVI in patients with hepatocellular carcinoma (P＜0.05). The scoring system composed of the above risk factors had good goodness of fit (χ2 = 2.553, P=0.862), area under the curve=0.787, P＜0.01, the optimal cut-off value was 2, the specificity was 0.814, and the sensitivity was 0.632. The results of survival analysis showed that the RFS rate of patients was significantly higher in the MVI low-risk group than that of patients in the MVI high-risk group (Log-rank χ2 =37.584, P＜0.01). Conclusion Preoperative GLR, ALRI, AFP and maximum tumor diameter are independent risk factors for MVI, and the predictive model composed of them has certain predictive value for the presence of MVI before surgery and postoperative recurrence. [ABSTRACT FROM AUTHOR]

Objective To investigate the effect of wide surgical margin on the prognosis of patients with single intrahepatic cholangiocarcinoma (ICC) undergoing hepatectomy and the effect of microvascular invasion (MVI) on the treatment of hepatectomy with both wide surgical margin and narrow surgical margin. Methods From December 2011 to December 2017, the clinicopathological data of 302 patients with single ICC who underwent radical resection were retrospectively studied in 13 medical centers. According to the width of surgical margin, there were 126 patients (41.7%) in wide surgical margin group (≥1 cm) and 176 patients (58.3%) in narrow surgical margin group (0.05). Disease-free survival rate in wide surgical margin group before PSM was significantly higher than that in narrow surgical margin group (P=0.005), while overall survival rate showed no statistically significant difference (P=0.053). After PSM, both overall survival rate and disease-free survival rate in wide surgical margin group were significantly higher than those in narrow surgical margin group (P0.05). In MVI negative group, however both overall survival rate and disease-free survival rate were significantly higher in the patients with wide surgical margin hepatectomy than in those with narrow surgical margin (P

The high recurrence rate of hepatocellular carcinoma (HCC) after surgery cannot be ignored. There is no consensus or guideline recommendation regarding adjuvant treatment after HCC surgery. Existing studies have shown that microvascular invasion is one of the high risk factors for recurrence after HCC. 1. For HCC patients with microvascular invasion, timely adjuvant therapy after surgery may delay the recurrence time and benefit the patient. At this stage, adjuvant therapy is used to prevent HCC recurrence and prolong survival after surgery. In recent years, HCC microvessels have received increasing attention. The research progress of adjuvant treatment after invasion is reviewed in order to provide reference and help for the adjuvant treatment of HCC patients with microvascular invasion. [ABSTRACT FROM AUTHOR]

Objective To investigate the combined value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) in predicting pathological microvascular invasion (pMVI) preoperatively, and to determine the relationship between prediction results and prognosis in hepatocellular carcinoma (HCC) patients. Methods A total of 181 newly diagnosed HCC patients were enrolled in this study. Imaging characteristics and the apparent diffusion coefficient (ADC) value of DWI were analyzed. The differences of imaging characteristics and ADC values between different pMVI groups were analyzed.Multivariate logistic regression and receiver operating characteristic (ROC) curve were used to analyze the value for pMVI prediction by using significant parameters. The patients were grouped based on MRI predicted MVI (mrMVI), and the relationship between mrMVI and recurrence free survival time (RFS) was analyzed. Results Fifty-one patients were pMVI positive and 130 patients were pMVI negative. The ADC value in pMVI positive group were (1.10±0.17)×10-3 mm2/s, significantly lower than (1.27±0.22)×10-3 mm2/s of pEMVI negative group (P<0.001). The incidence rates of incomplete enhancing "capsule", non-smooth tumor margin, arterial peritumoral enhancement, mosaic architecture and peritumoral hypointensity on hepatobiliary phase (HBP) in pMVI positive group were significantly higher than those of negative group (all P<0.05). Multivariate logistic regression analysis showed that tumor margin, arterial peritumoral enhancement, peritumoral hypointensity on HBP and ADC value were independently associated with pMVI. ROC analysis showed that the area under curve, sensitivity and specificity of pMVI predicted by combined parameters were 0.830, 76.5% and 81.5%, respectively. The median RFS of mrMVI positive group was 23.6 months, significantly lower than 38.2 months of mrEMVI negative group (P=0.004). Conclusion Tumor margin, arterial peritumoral enhancement, peritumoral hypointensity on HBP and ADC value are independent predictors of pMVI in HCC, and mrMVI is related with RFS. [ABSTRACT FROM AUTHOR]

Objective To explore the correlation between hepatitis B virus (HBV) infection and antiviral therapy and the formation and development of microvascular invasion (MVI) for hepatocellular carcinoma (HCC). Methods Retrospective analysis was made on the clinical and pathological data of hepatocellular carcinoma patients undergoing radical hepatectomy in the Second Affiliated Hospital of Kunming Medical University from March 2016 to October 2018. Results The formation of MVI was related to preoperative antiviral therapy, HBVDNA quantification, AFP quantification and postoperative histopathological grading.Among hbV-associated HCC patients, multivariate Logistic regression analysis showed that antiviral therapy (OR = 0.44 p = 0.002), HBVDNA quantification ≥2×104～≤2×107 IU/mL (OR = 2.79 p = 0.036), and AFP quantification ≥400 ～≤ 1 000 ng/mL (OR = 0.31 p = 0.023) were independent risk factors for MVI, and antiviral therapy for more than half a year was independent protective factor for MVI. High levels of HBVDNA quantification (> 2×104 IU/mL) may indicate high differentiation of MVI (P < 0.05). In addition, significant HBVDNA quantification ≥2×104～≤ 2×107 IU/mL (AUC = 0.885 P < 0.001) may be of high diagnostic value in predicting the occurrence of MVI for HBV-associated HCC. Conclusion HBV infection and HBVDNA quantification levels are important factors in the formation of MVI in hepatocellular carcinoma. Antiviral therapy may have a preventive effect on the formation of MVI.A high level of HBVDNA quantification may indicate highly differentiated MVI. In addition, meaningful HBVDNA quantification is of certain value for THE occurrence of MVI in HBV-associated HCC. [ABSTRACT FROM AUTHOR]

Objective To investigate the value of microvascular invasion(MVI) grade versus TNM stage and Barcelona Clinic Liver Cancer(BCLC) stage in predicting the early recurrence of hepatocellular carcinoma(HCC) after radical hepatectomy and the clinical value of MVI grade through a retrospective analysis of the prognosis of patients after HCC surgery.Methods A total of 100 HCC patients who underwent radical hepatectomy in Department of Hepatobiliary Surgery,The Second Affiliated Hospital of Kunming Medical University,from December2015 to December 2017 were enrolled,and according to the results of the 2-year follow-up,these patients were divided into recurrence group with 49 patients and non-recurrence group with 51 patients.Laboratory markers and MVI grade were compared between the two groups,and MVI grade,TNM stage,and BCLC stage were compared in terms of their value in predicting 2-year recurrence-free survival(RFS) after surgery.The t-test was used for comparison of normally distributed continuous data between groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups;the chi-square test was used for comparison of non-ranked data between two groups,and the Mann-Whitney U test was used for comparison of ranked data between groups;the Kruskal-Wallis H test was used for comparison between three groups,and the Bonferroni method was used for further comparison between two groups.The Kaplan-Meier method was used to plot survival curves,and the log-rank test was used for survival analysis.The consistency index calculated by RMS package was used to compare the predictive value of clinicopathological staging systems.Results Compared with the non-recurrence group,the recurrence group had significantly higher alpha-fetoprotein level(Z=0.099,P<0.05) and proportion of patients with MVI(Z=-2.651,P=0.008).After 2 years of follow-up,there were 47 patients in M0 group,34 in M1 group,and 19 in M2 group;18 patients in the M0 group(38.3%),16 in the M1 group(47.1%),and 15 in the M2 group(78.9%) experienced recurrence,and there was a significant difference in recurrence between the three groups(H=8.934,P=0.011);further comparison between two groups showed that the M2 group had a significantly higher number of patients with recurrence than the M0 group and the M1 group(P<0.05).The cumulative recurrence rate was 41.9% in the M0 + M1 group and 78.9% in the M2 group,and there was a significant difference between these two groups(χ2=11.445,P<0.001);the M2 group had a significantly lower 2-year RFS rate than the M0 + M1 group.As for BCLC stage,the cumulative recurrence rate was 36.2% in the patients with early-stage(stage 0 + stage 1) HCC and 66.7% in those with middle-and late-stage(stage 2 + stage 3) HCC,and there was a significant difference between the two groups(χ2=5.047,P=0.012);the middle-and late-stage group had a significantly lower 2-year RFS rate than the early-stage group.As for TNM stage,the cumulative recurrence rate was 24.5% in the patients with stage Ⅰ HCC and 72.5% in those with stage Ⅱ + Ⅲ HCC,and there was a significant difference between the two groups(χ2=17.223,P<0.001);the stage Ⅱ + Ⅲ group had a significantly lower 2-year RFS rate than the stage I group.TNM stage had the highest value in predicting 2-year RFS,while MVI and BCLC stage had a similar predictive value(consistency index:0.659 vs 0.598 vs 0.600).Conclusion Compared with MVI patients with no risk or low risk,patients with high-risk MVI have a significantly higher probability of early recurrence,and thus MVI may become an evaluation target for postoperative treatment. [ABSTRACT FROM AUTHOR]

To investigate the clinical prognosis of the liver transplant recipients diagnosed with hepatocellular carcinoma (HCC) complicated with microvascular invasion (MVI). Methods Clinical data of 3 447 HCC recipients undergoing liver transplantation were extracted from Surveillance, Epidemiology, and End Results (SEER) database of American National Cancer Institute. According to the incidence of MVI, all recipients were divided into MVI (n=376) and non-MVI groups (n=3 071). The clinical prognosis of liver transplant recipients was statistically compared between two groups by analyzing the 1-, 3- and 5-year overall survival (OS) and liver cancer specific survival (LCSS). Relevant clinical data including age, gender, race, pathological staging, tumor size, lymph node metastasis, distant metastasis, tumor-node-metastasis (TNM) staging and MVI were recorded in two groups. The independent risk factors of clinical prognosis of HCC recipients undergoing liver transplantation were analyzed by multivariate Cox regression model. The nomogram for predicting the clinical prognosis of the recipients was delineated. The accuracy of the prediction model was evaluated by the consistency index. Results In the non-MVI group, the 1-, 3- , 5-year OS and LCSS were 93.5%, 82.1%, 75.3% and 98.3%, 93.8%, 90.7%, significantly higher than 88.8%, 72.1%, 68.4% and 95.3%, 83.1%, 80.4% in the MVI group (all P<0.05). Multivariate regression analysis showed that pathological staging, tumor size, lymph node metastasis, distant metastasis, TNM staging and MVI were the independent risk factors of OS and LCSS in HCC recipients undergoing liver transplantation (all P<0.05). The nomogram consistency index was calculated as 0.624 (0.602- 0.648). Conclusions MVI is an independent risk factor of the clinical prognosis of HCC recipients undergoing liver transplantation, which is significantly correlated with poor prognosis of the recipients. The nomogram based on MVI can predict the clinical prognosis of these recipients. [ABSTRACT FROM AUTHOR]

The prognosis of hepatocellular carcinoma(HCC) is closely associated microvascular invasion(MVI), and in recent years, more and more clinical studies have been conducted on MVI, but there are few articles on the development of basic pathology and related controversies. As the basis of clinical research, it is of great significance to understand the definition of MVI and the controversy over pathological grading. With reference to related articles, this article reviews the development history of the definition of MVI, analyzes the current status of the research on the criteria for pathological grading of MVI, and assesses the value of different criteria in predicting postoperative recurrence of HCC, so as to provide a reference for the clinical research on MVI. [ABSTRACT FROM AUTHOR]

Objective: To predict microvascular invasion (MVI) in hepatocellular carcinoma (HCC) using a model based on multiphase dynamic-enhanced CT (DCE-CT) radiomics feature and hierarchical fusion of multiple classifiers., Methods: We retrospectively collected preoperative DCE-CT images from 111 patients with pathologically confirmed HCC in Guangzhou First People's Hospital between January, 2016 and April, 2020. The volume of interest was outlined in the early arterial phase, late arterial phase, portal venous phase and equilibrium phase, and radiomics features of these 4 phases were extracted. Seven classifiers based on different algorithms were trained using the filtered feature subsets to obtain multiple base classifiers under each phase. According to the hierarchical fusion strategy, a multi-criteria decision-making-based weight assignment algorithm was used for fusing each base classifier under the same phase with the model after extracting the phase information to obtain the prediction model. The proposed model was evaluated using a 5-fold cross-validation and assessed for area under the ROC curve (AUC), accuracy, sensitivity, and specificity. The prediction model was also compared with the fusion models using a single phase or multiple phases, models based on a single phase with a single classifier, models with different base classifier diversities, and 8 classifier models based on other ensemble methods., Results: The experimental results showed that the performance of the proposed model for predicting HCCMVI was optimal after incorporating the 4 phases and 7 classifiers, with AUC, accuracy, sensitivity, and specificity of 0.828, 0.766, 0.877, and 0.648, respectively. Comparative experiments showed that this prediction model outperformed the models based on a single phase with a single classifier and other ensemble models., Conclusion: The proposed prediction model is effective for predicting MVI in HCC with superior performance to other models.

Objective To investigate the influencing factors for microvascular invasion (MVI) in patients with single hepatocellular carcinoma (SHCC) and their prognosis. Methods A retrospective analysis was performed for the clinical data of 138 patients with SHCC who were admitted to The First Hospital of Jilin University from January 2012 to December 2014 and underwent radical hepatectomy. The receiver operating characteristic curve was plotted based on neutrophil, platelet count (PLT), fibrinogen, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, fibrinogen-albumin ratio, and presence or absence of MVI. The logistic regression model was used for univariate and multivariate analyses, and odds ratio (OR) and 95% confidence interval (CI) were used to evaluate association. The Kaplan-Meier method was used to calculate disease-free survival rate and plot survival curves of patients with or without MVI, and the log-rank test was used for survival analysis. Results The univariate analysis showed that sex (OR=0.400, 95%CI: 0.162-0.985, P=0.046), tumor diameter (OR=5.902, 95%CI: 2.813-12.382, P＜0.001), alpha-fetoprotein (AFP) (OR=2.635, 95%CI: 1.286-5.398, P=0.008), neutrophil (OR=3.019, 95%CI: 1.353-6.736, P=0.007), PLT (OR=2.255, 95%CI: 1.116-4.555, P=0.023), fibrinogen (OR=3.483, 95%CI: 1.687-7.190, P=0.001), gamma-glutamyl transferase (OR=2.115, 95%CI: 1.069-4.182, P=0.031), neutrophil-lymphocyte ratio (OR=3.662, 95%CI: 1.803-7.436, P＜0.001), platelet-lymphocyte ratio (OR=3.734, 95%CI: 1.649-8.455, P=0.002), and fibrinogen-albumin ratio (OR=3.014, 95%CI: 1.497-6.070, P=0.002) were associated with MVI in patients with SHCC. The multivariate analysis indicated that tumor diameter (OR=5.423, 95%CI: 2.555-11.511, P＜0.001) and AFP (OR=2.195, 95%CI: 1.010-4.774, P=0.047) were independent factors for MVI. The prognostic analysis showed that the 1- and 3-year disease-free survival rates were 66.4% and 52.8%, respectively, in patients with MVI and 90.6% and 71.5%, respectively, in patients without MVI, and there were significant differences between these two groups of patients ( χ2=10.929 and 4.043, both P＜0.05). There was also a significant difference in disease-free survival curve between the two groups ( χ2=7.860, P＜0.05). Conclusion Tumor diameter and preoperative AFP level are independent factors for MVI in patients with SHCC, and SHCC patients with MVI tend to have poor prognosis. [ABSTRACT FROM AUTHOR]

Objective To investigate the recurrence rate, the efficacy and safety of auxiliary hepatic arterial chemoembolization after the treatment of microvascular invasion (MIV) of hepatocellular carcinoma. Methods A total of 104 patients with hepatocellular carcinoma clinical staging of early metaphase were collected from the First Affiliated Hospital of Xi'an Jiaotong University in Jan．2010 to Dec.2016, all treated with liver resection and follow-ups. Adopting the method of retrospective analysis, univariate and multivariate analyses were performed to investigate the risk factors for recurrence-free survival(RFS)and overall survival(OS). Multiple logistic regression was used to identify the clinicopathological characteristics associated with MVI. The rates of RFS and OS were compared among patients with or without MVI treated with liver resection alone or followed by PA-TACE. Results In HCC patients, the gender HBsAg, total bilirubin, and prothrombin time, AFP, HBV - DNA, the size of largest tumor, capsule, operation type, hepatic door block, Child - Pugh grade, classification comparison differences had no statistical significance between the two groups of with or without TACE(P>0.05); Age, nodules, tumor cell resection, and BCLC were statistically significant in the non-MIV infiltration group (P<0.05).Hypersplenism and recurrence rate were statistically significant in MIV group (P<0.05). Univariate and multivariate analyses demonstrated that AFP (> 400 ng/mL), tumor diameter, membrane integrity, MVI， and most liver resection were significantly associated with overall survival rates (P<0.05), the AFP (>400 ng/mL), Child - Pugh, grade B, tumor diameter, hepatocellular carcinoma (HCC) and other abnormal degree, membrane integrity, MVI have significant correlation with disease-free survival rate (P< 0.05). Multiple logistic regression identified serum AFP level > 400 ng/L, tumor size > 5cm, and incomplete tumor envelope was independent correlation factor (P>0.05). In the HCC patients with MIV, both OS and DFS were significantly improved in patients who received PA-TACE as compared to those who underwent liver resection alone (P> 0.05), but no significant effect in HCC patients wieh no MIV invasion (P> 0.05). Conclusions There is a certain correlation between microvascular infiltration and the recurrence rate and survival rate of hepatocellular carcinoma, and the method of using adjuvant hepatic arterial chemoembolization is helpful to reduce the recurrence rate and prolong the survival period. [ABSTRACT FROM AUTHOR]

Objective To investigate the relationship between contactin (CNTN)-1 and vascular endothelial growth factor (VEGF)-C expression levels and the recurrence, metastasis and prognosis of hepatocellular carcinoma(HCC) patients after liver transplantation. Methods Clinical data and pathological specimen of 105 patients diagnosed with primary HCC undergoing orthotopic liver transplantation were collected. The expression levels of CXTN-1 and VEGF-C in the cancerous and para-cancerous liver tissues were quantitatively measured by immunohistochemical staining. The relationship between the CNTN-1 and VEGF-C expression levels and clinicopathological characteristics, postoperative recurrence, metastasis and prognosis was statistically analyzed. Results The high expression rate of CNTN-1 and VEGF-C in liver cancerous tissues was 46.7% and 39.0%. significantly higher compared with 11.4% and 19.0% in the para-cancerous tissues (both P<0.05). Spearman correlation analysis revealed that the expression level of CNTN-1 was positively correlated with that of VEGF-C (P<0.005). ) X2 test demonstrated that the expression of CNTN-1 protein was positively correlated with the level of alpha fetoprotein (AFP) (p=0.17). tumor, node, metastasis (TNM) staging (all P<0.001). and negatively correlated with the degree of differentiation (P<0.001). High expression of VEGF-C was positively correlated with TNM staging (P

Objective: To investigate the consistency and diagnostic performance of magnetic resonance imaging (MRI) for detecting microvascular invasion (MVI) of hepatocellular carcinoma (HCC) and the validity of deep learning attention mechanisms and clinical features for MVI grade prediction., Methods: This retrospective study was conducted among 158 patients with HCC treated in Shunde Hospital Affiliated to Southern Medical University between January, 2017 and February, 2020. The imaging data and clinical data of the patients were collected to establish single sequence deep learning models and fusion models based on the EfficientNetB0 and attention modules. The imaging data included conventional MRI sequences (T 1 WI, T 2 WI, and DWI), enhanced MRI sequences (AP, PP, EP, and HBP) and synthesized MRI sequences (T1mapping-pre and T1mapping-20 min), and the high-risk areas of MVI were visualized using deep learning visualization techniques., Results: The fusion model based on T1mapping-20min sequence and clinical features outperformed other fusion models with an accuracy of 0.8376, a sensitivity of 0.8378, a specificity of 0.8702, and an AUC of 0.8501 for detecting MVI. The deep fusion models were also capable of displaying the high-risk areas of MVI., Conclusion: The fusion models based on multiple MRI sequences can effectively detect MVI in patients with HCC, demonstrating the validity of deep learning algorithm that combines attention mechanism and clinical features for MVI grade prediction.

Objective To correlate preoperative dynamic Gd-EOB-DTPA-enhanced MRI with histopathological microvascular invasion (MVI) in solitary hepatocellular carcinoma (HCC). Methods The preoperative dynamic Gd-EOB-DTPA-enhanced MRI of 66 patients with HCC was analyzed and compared with the pathologic findings. Univariate, multiple logistic regression analyses were performed to determine the correlation and receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic value of tumor diameter. Results Univariate analysis showed that the tumor diameter (P=0.011), tumor margin (P=0.019), peritumor enhancement (P=0.001), and peritumor hypointensity in the hepatobiliary phase (P=0.002) were risk factors for MVI. The signal homogeneity (P=0.157), tumor capsule (P=0.207), ADC values (P=0.481), and T1 reduction ratio (P=0.689) did not correlate with MVI. Multiple logistic regression analysis showed that the tumor diameter (P=0.007;OR=1.024) and peritumor enhancement (P=0.005; OR=6.670) were independent risk factors for MVI. At a cutoff value of tumor size ＞56 mm, the area under the curve was 0.741 for predicting microvascular invasion with 58.8％ sensitivity and 83.3％ specificity in ROC curve analysis. The incidence rate of MVI was 52.4％ in peritumor enhancement. Conclusion Preoperative dynamic Gd-EOB-DTPA-enhanced MRI has predictive value for MVI in HCC. MVI is more likely in larger tumors or peritumor enhancement. [ABSTRACT FROM AUTHOR]

Microvascular invasion (MVI) is an independent predictor of early recurrence and poor prognosis following hepatocellular carcinoma (HCC) resection and transplantation. As a novel non-invasive diagnostic tool, radiomics can extract the quantitative imaging features of tumors and peritumoral tissues with high throughput, providing more information on tumor heterogeneity than conventional and functional imaging of visual analysis and having a good application prospect in predicting the presence of MVI in HCC patients, thereby improving the accuracy of HCC diagnosis and prognosis. The value of the multimodal radiomics method based on various imaging methods in evaluating the possibility of MVI in HCC patients is elucidated here in combination with the latest research progress.

Objectives: Microvascular invasion (MVI) is an important predictor of postoperative recurrence or poor outcomes of hepatocellular carcinoma (HCC). Radiomics is able to predict MVI in HCC preoperatively. This study aims to investigate the influence of different region of interest (ROI) sizes on CT-based radiomics model for MVI prediction in HCC., Methods: Patients with HCC with or without MVI confirmed by pathology and those who underwent preoperative plain or enhanced abdominal CT scans in the Third Xiangya Hospital of Central South University from January 2010 to December 2020 were retrospectively and consecutively included. According to the ratio of 7 to 3, the patients were randomly assigned into a training set and a validation set. Clinical data were collected from medical records, and radiomics features were extracted from the arterial phase (AP) and portal venous phase (PVP) of preoperatively acquired CT in all patients. Six different ROI sizes were employed. The original ROI (OROI) was manually delineated along the visible borders of the tumor layer-by-layer. The OROI was expanded out by 1-5 mm. The OROI was combined with 5 different peritumoral regions to generate the other 5 ROIs, named Plus1-Plus5. Feature extraction, dimension reduction, and model development were conducted in 6 different ROIs separately. Supporter vector machine (SVM) was used for model construction. Model performance was assessed via receiver operating characteristic (ROC) curve., Results: A total of 172 HCC patients were included, in which 83 (48.3%) were MVI positive, and 89 (51.7%) were MVI negative. Three hundred and ninety-six features based on AP or PVP images were extracted from each ROI. After feature selection and dimension reduction, 4, 5, 15, 11, 6, and 3 features of OROI, Plus1, Plus2, Plus 3, Plus4, and Plus5 were selected for model construction, respectively. In the training set, the sensitivity, specificity, and area under the curve (AUC) of OROI were 0.759, 0.806, and 0.855, respectively. The AUC values of Plus2 (0.979) and Plus3 (0.954) were higher than that of OROI. The AUC values of Plus1 (0.802), Plus4 (0.792), and Plus5 (0.774) were not significantly different from those of OROI. In the validation set, the sensitivity, specificity, and AUC value of OROI were 0.640, 0.630, and 0.664, respectively. The AUC value of Plus3 was 0.903, which was higher than that of OROI. The AUC values of Plus1 (0.679), Plus2 (0.536), Plus4 (0.708), and Plus5 (0.757) were not significantly different from that of OROI ( P >0.05)., Conclusions: The size of ROI significantly inflluences on the performance of CT-based radiomics model for MVI prediction in HCC. Including appropriate area around the tumor into ROI could improve the predictive performance of the model, and 3 mm might be appropriate distance.

Objective: To study the effect of sorafenib and prophylactic transarterial chemoembolization (TACE) for prevention of postoperative relapse in patients with liver cancer combined with microvascular invasion (MVI) after using radical hepatectomy. Methods: A retrospective analysis was performed on 137 cases that underwent radical hepatectomy at the First Affiliated Hospital of Zhengzhou University from August 2015 to January 2018. Clinical data of liver cancer patients with MVI were diagnosed by postoperative pathology. General data of the three groups were analyzed. Kaplan-Meier was used to calculate the tumor-free survival rate. COX proportional hazards-model was used to analyze the independent risk factors for postoperative recurrence of liver cancer with MVI recurrence. Counting data was compared by x(2) test between groups, and log-rank test was used to compare the tumor-free survival rates. Results: A, B, and C groups had 49, 36, and 52 cases, respectively. General clinicopathological data of the three groups were not statistically significant. The postoperative tumor-free survival rates at 1-, 2-, and 3-years were 71.4%, 51.0%, 38.8%, 86.1%, 75.0%, 66.7%, and 82.7%, 75.0%, and 59.6% respectively in A, B, and C groups. Multivariate Cox proportional-hazards regression model showed that patients' age ( HR = 0.622, P = 0.046), maximum tumor diameter ( HR = 1.661, P = 0.033), prophylactic TACE ( HR = 0.544, P = 0.019), and postoperative use of sorafenib ( HR = 0.419, 0.222, 0.791, P = 0.007) were independent risk factors for postoperative recurrence of liver cancer with MVI. Conclusion: Sorafenib or prophylactic TACE use can significantly reduce the recurrence rate within 3 years after radical surgery in patients with liver cancer who were confirmed to have MVI by postoperative pathology.

Hepatocellular carcinoma (HCC) is the most common malignant tumors of liver. Rational treatment in early stage of HCC can significantly increase the survival rate of patients. Detection of early-stage liver lesions through diffusion-weighted imaging, diffusion kurtosis imaging, incoherent motion within voxels, magnetic resonance spectroscopy imaging, dynamic contrast-enhanced imaging, or other functional imaging can accurately evaluate grade of malignancy and guide towards the curative effect of different treatment schemes. Volumetric interpolated breath-hold examination (VIBE) with three techniques, namely, CAIPIRINHA, Dixon, and TWIST, i.e., CDT-VIBE sequence can provide multiple sets of arterial phase images in a short time, and detect small foci transient enhancement that cannot be detected by other examinations, and the differences in initial enhancement phase of apparent lesions are of great significance for suggesting hemodynamic characteristics. In addition, magnetic resonance imaging predicts microvascular invasion of HCC, i.e., indirectly predicts HCC lesions recurrence rate, and overall survival time after liver transplantation. This article reviews the current research progress of magnetic resonance imaging technology in HCC.

Objective: To compare the efficacy and safety of anatomic hepatectomy and non-anatomic hepatectomy in the treatment of single small Hepatocellular carcinoma with MVI. Methods: The clinical data of 84 patients with single small Hepatocellular carcinoma with MVI in Beijing Chaoyang Hospital between January 2008 and December 2013 were retrospectively analyzed. Patients undergoing anatomical hepatectomy were enrolled in the AR group, and the patients undergoing non-anatomic hepatectomy were enrolled in the NR group. The efficacy and survival rate of the two groups were compared. Results: (1) Operation time, numbers of patients with volume of intraoperative blood loss ≥300 ml and number of patients with blood transfusion were (170±41)minutes, 8, 7 in the AR group and (148±35)minutes, 19, 18 in the NR group, respectively, with statistically significant differences between the 2 groups ( P <0.05). (2) The 1-year, 2-year and 3-year overall survival rate were 85.7%, 68.6%, 57.1% in the AR group and 79.6%, 53.1%, 42.9% in the NR group, respectively. The 1-year, 2-year and 3-year progression-free survival rate were 80.0%, 62.9%, 51.4% in the AR group and 71.4%, 49.0%, 38.8%, in the NR group, respectively. There were statistically significant differences between the 2 groups both in the overall survival rate and the progression-free survival rate ( P <0.05). (3) Prognostic factors analysis of HCC patients with MVI: result of univariate analysis showed that maximum diameter of tumor and surgical procedures were relative factors affecting overall survival and progression-free survival of HCC patients with MVI, AFP level was relative factors affecting progression-free survival of HCC patients with MVI, with statistically significant differences ( P <0.05). Result of multivariate analysis showed that maximum diameter of tumor between 3.0 and 5.0 cm and non-anatomic liver resection were independent factors affecting poor overall survival and progression-free survival of HCC patients with MVI, and AFP≥20 μg/L and total bilirubin ≥20 μmol/L were independent factors affecting poor progression-free survival of HCC patients with MVI, with a statistically significant differences ( P < 0.05). Conclusion: Anatomic hepatectomy for patients with single small hepatocellular carcinoma with microvascular invasion has better clinical efficacy and safety.