Pattern of macrovascular invasion in hepatocellular carcinoma.

Maria Guarino, Alessandro Cucchetti, Giuseppina Pontillo, Fabio Farinati, Francesca Benevento, Gian Ludovico Rapaccini, Maria Di Marco, Eugenio Caturelli, Marco Zoli, Sacco Rodolfo, Giuseppe Cabibbo, Fabio Marra, Andrea Mega, Antonio Gasbarrini, Gianluca Svegliati-Baroni, Francesco Giuseppe Foschi, Gabriele Missale, Alberto Masotto, Gerardo Nardone, Giovanni Raimondo, Francesco Azzaroli, Gianpaolo Vidili, Filippo Oliveri, Franco Trevisani, Edoardo G Giannini, Filomena Morisco

Journal: European journal of clinical investigation 2021;51(7):e13542

PMID: 33755196

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Abstract

BACKGROUND AND AIMS

In patients with hepatocellular carcinoma (HCC), macrovascular invasion (MaVI) limits treatment options and decreases survival. Detailed data on the relationship between MaVI extension and patients' characteristics, and its impact on patients' outcome are limited. We evaluated the prevalence and extension of MaVI in a large cohort of consecutive HCC patients, analysing its association with liver disease and tumour characteristics, as well as with treatments performed and patients' survival.

METHODS

We analysed data of 4774 patients diagnosed with HCC recorded in the Italian Liver Cancer (ITA.LI.CA) database (2008-2018). Recursive partition analysis (RPA) was performed to evaluate interactions between MaVI, clinical variables and treatment, exploring the inter-relationship determining overall survival.

RESULTS

MaVI prevalence was 11.1%, and median survival of these patients was 6.0 months (95% CI, 5.1-7.1). MaVI was associated with younger age at diagnosis, presence of symptoms, worse Performance Status (PS) and liver function, high alphafetoprotein levels and large HCCs. MaVI extension was associated with worse PS, ascites and greater impairment in liver function. RPA identified patients' categories with different treatment indications and survival, ranging from 2.4 months in those with PS > 1 and ascites, regardless of MaVI extension (receiving best supportive care in 90.3% of cases), to 14.1 months in patients with PS 0-1, no ascites and Vp1-Vp2 MaVI (treated with surgery in 19.1% of cases).

CONCLUSIONS

MaVI presence and extension, together with PS and ascites, significantly affect patients' survival and treatment selection. The decision tree based on these parameters may help assess patients' prognosis and inform therapeutic decisions.

Address: Department of Clinical Medicine and Surgery, Gastroenterology Unit, University of Napoli "Federico II", Napoli, Italy.; Department of Medical and Surgical Sciences, General Surgery of the Morgagni-Pierantoni Hospital Forlì, Alma Mater Studiorum - University of Bologna, Bologna, Italy.; Department of Internal Medicine, Ospedale per gli Infermi di Faenza, Faenza, Italy.; Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.; Division of Internal Medicine, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.; Gastroenterology Unit, IRCCS, Fondazione Policlinico Universitario A. Gemelli, Roma, Italy.; Medicine Unit, Bolognini Hospital, Seriate, Italy.; Gastroenterology Unit, Belcolle Hospital, Viterbo, Italy.; Department of Medical and Surgical Sciences, Internal Medicine Unit, University of Bologna, Bologna, Italy.; Gastroenterology and Digestive Endoscopy Unit, Foggia University Hospital, Foggia, Italy.; Department of Health Promotion, Mother & Child Care, Internal Medicine & Medical Specialties, PROMISE, Gastroenterology & Hepatology Unit, University of Palermo, Palermo, Italy.; Department of Experimental and Clinical Medicine, Internal Medicine and Hepatology Unit, University of Firenze, Firenze, Italy.; Gastroenterology Unit, Bolzano Regional Hospital, Bolzano, Italy.; Internal Medicine and Gastroenterology Unit, Policlinico Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy.; Gastroenterology Unit, Polytechnic University of Marche, Ancona, Italy.; Department of Internal Medicine, Ospedale per gli Infermi di Faenza, Faenza, Italy.; Infectious Diseases and Hepatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.; Gastroenterology Unit, Ospedale Sacro Cuore Don Calabria, Negrar, Italy.; Department of Clinical Medicine and Surgery, Hepato-Gastroenterology Unit, University of Napoli "Federico II", Napoli, Italy.; Department of Clinical and Experimental Medicine, Clinical and Molecular Hepatology Unit, University of Messina, Messina, Italy.; Department of Surgical and Medical Sciences, Gastroenterology Unit, Alma Mater Studiorum-Università of Bologna, Bologna, Italy.; Department of Medical, Surgical and Experimental Sciences, Clinica Medica Unit, University of Sassari, Azienda Ospedaliero-Universitaria di Sassari, Sassari, Italy.; Department of Clinical and Experimental Medicine, Hepatology and Liver Physiopathology Laboratory and Internal Medicine, University of Pisa, Pisa, Italy.; Department of Medical and Surgical Sciences, Semeiotics Unit, Alma Mater Studiorum-University of Bologna, Bologna, Italy.; Department of Internal Medicine, Gastroenterology Unit, IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy.

DOI: 10.1111/eci.13542

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MeSH Terms: Ablation Techniques, Aged, Antineoplastic Agents, Ascites, Carcinoma, Hepatocellular, End Stage Liver Disease, Female, Hepatectomy, Hepatitis B, Chronic, Hepatitis C, Chronic, Humans, Italy, Liver Diseases, Alcoholic, Liver Neoplasms, Liver Transplantation, Male, Mesenteric Veins, Middle Aged, Neoplasm Invasiveness, Non-alcoholic Fatty Liver Disease, Patient Acuity, Portal Vein, Prognosis, Registries, Sorafenib, Survival Rate, Tumor Burden