Presence of mVI/S predicts aggressive recurrence of HCC after liver resection

Microvascular invasion and/or satellitosis (mVI/S) is independently associated with aggressive recurrence and mortality in hepatocellular carcinoma (HCC) patients treated with liver resection (LR), a recent study has shown. 

This retrospective study included 218 patients with HCC (30 percent BCLC 0 and 70 percent BCLC A) treated with LR between February 2000 and November 2020. The median tumour size was 28 mm. 

The investigators recorded the main clinical variables, and two independent pathologists assessed blindly the histological features. Aggressive recurrence was defined as exceeding the Milan criteria at first recurrence. 

The prevalence of mVI/S was 39 percent, with a kappa-index of 0.8 between the two pathologists. Of the patients, 61 (28 percent) died, 32 (15 percent) underwent liver transplantation, and 127 (58 percent) had HCC recurrence during a median follow-up of 49 months. 

Aggressive recurrence had a 35-percent prevalence (44/127 Milan-out, with 20 patients at advanced stage), while the 5-year survival stood at 81 percent. 

Of note, mVI/S presence was the only independent predictor of recurrence (hazard ratio [HR], 1.83, 95 percent confidence interval [CI], 1.28–2.61; p<0.001), aggressive recurrence (HR, 3.31, 95 percent CI, 1.74–6.29; p<0.001), and death (HR, 2.23, 95 percent CI, 1.27–3.91; p=0.005). 

In addition, the macrotrabecular-massive subtype showed significant associations with a higher prevalence of mVI/S, Edmonson Steiner grade III-IV, AFP values, and vessels that encapsulate tumour clusters, but not with recurrence, aggressive recurrence, or overall survival. 

These findings have “important implications for early-stage patient management, especially in the setting of adjuvant immunotherapy or ab initio liver transplantation,” the investigators said.