title: Limitations of predicting microvascular invasion in patients with hepatocellular cancer prior to liver transplantation.
abstract: Microvascular invasion (MVI) is well known to negatively influence outcomes following surgical treatment of hepatocellular cancer (HCC) patients. The aim of this study was to evaluate the rationale for prediction of MVI before liver transplantation (LT). Data of 200 HCC patients after LT were subject to retrospective analysis. MVI was present in 57 patients (28.5%). Tumor number (p = 0.001) and size (p = 0.009), and alpha-fetoprotein (p = 0.049) were independent predictors of MVI used to create a prediction model, defined as: 0.293x(tumor number) + 0.283x(tumor size in cm) + 0.164xloge(alpha-fetoprotein in ng/ml) (c statistic  =  0.743). The established cut-off (≥2.24) was associated with sensitivity and specificity of 72%. MVI was not an independent risk factor for recurrence (p = 0.307), in contrast to tumor number (p = 0.047) and size (p < 0.001), alpha-fetoprotein (p < 0.001) and poor differentiation (p = 0.039). Recurrence-free survival at 5 years for patients without MVI was 85.9% as compared to 83.3% (p = 0.546) and 55.3% (p = 0.001) for patients with false negative and true positive prediction of MVI, respectively. The use of both morphological and biological tumor features enables effective pre-transplant prediction of high-risk MVI. Provided that these parameters are combined in selection of HCC patients for LT, pre-transplant identification of all patients with MVI does not appear necessary.
authors.affiliation: Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Poland.
authors.forename: Michał
authors.initials: M
authors.lastname: Grąt
authors.affiliation: Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Poland.
authors.forename: Jan
authors.initials: J
authors.lastname: Stypułkowski
authors.affiliation: Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Poland.
authors.forename: Waldemar
authors.initials: W
authors.lastname: Patkowski
authors.affiliation: Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Poland.
authors.forename: Emil
authors.initials: E
authors.lastname: Bik
authors.affiliation: Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Krasnodębski
authors.affiliation: Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Poland.
authors.forename: Karolina M
authors.initials: KM
authors.lastname: Wronka
authors.affiliation: Department of Epidemiology, Medical University of Warsaw, Poland.
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Lewandowski
authors.affiliation: Hepatology and Internal Medicine Unit, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Poland.
authors.forename: Michał
authors.initials: M
authors.lastname: Wasilewicz
authors.affiliation: Second Department of Clinical Radiology, Medical University of Warsaw, Poland.
authors.forename: Karolina
authors.initials: K
authors.lastname: Grąt
authors.affiliation: Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Poland.
authors.forename: Łukasz
authors.initials: Ł
authors.lastname: Masior
authors.affiliation: Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Poland.
authors.forename: Joanna
authors.initials: J
authors.lastname: Ligocka
authors.affiliation: Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Krawczyk
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D055806:Microvessels / Q000473:pathology*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009360:Neoplastic Cells, Circulating / Q000473:pathology; D011183:Postoperative Complications / Q000453:epidemiology / Q000378:metabolism / Q000473:pathology*; D011237:Predictive Value of Tests; D047368:Tumor Burden; D000509:alpha-Fetoproteins / Q000592:standards*
chemical_list: D000509:alpha-Fetoproteins