Microvascular Venous Invasion in Hepatocellular Carcinoma: Why Do Recurrences Occur?
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REVIEW ARTICLE
Microvascular Venous Invasion in Hepatocellular Carcinoma: Why Do Recurrences Occur? Burak Isik 1
&
Fatih Gonultas 1
&
Tolga Sahin 1 & Sezai Yilmaz 1,2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Hepatocellular carcinoma is the most common primary cancer of the liver. It is almost always associated with cirrhosis and it is usually diagnosed in later stages of the disease. Furthermore, recurrence rate following liver transplantation ranges between 15 and 30%. The most important factor determining the recurrence is vascular invasion. Methods In this review, the issue of microvascular invasion causing hepatocellular carcinoma recurrence is reviewed. Macroscopic vascular invasion is almost easy to diagnose on radiologic evaluation. However, microscopic vascular invasion is almost always diagnosed with pathologic evaluation. On the other hand, microscopic vascular invasion is associated with early recurrences and reduced disease-free survival. The type of vessel that is invaded determines the nature of the spread of the tumor cells. Invasion of the hepatic venous tributaries leads to systemic metastasis whereas portal venous invasions lead to intrahepatic spread of the tumor. Microscopic vascular invasion should be diagnosed before liver transplantation or liver resection in order to deliver the appropriate therapy to the patients. Results Yet, there is no ideal marker to suggest microscopic vascular invasion before any intervention. Markers such as alphafetoprotein, des carboxy prothrombin, or gamma-glutamyl transferase have been found to be correlated with microscopic vascular invasion. These parameters are not very efficient to be used in routine clinical practice. Conclusion Therefore, further research is needed to define ideal marker associated with microscopic vascular invasion. Keywords Hepatocellular carcinoma . Vascular invasion . Portal vein invasion . Hepatic vein invasion . Microscopic vascular invasion
Abbreviations AFP Alpha fetoprotein DCP Des-carboxy prothrombin HCC Hepatocellular carcinoma LT Liver transplantation MC Milan criteria mVI Microvascular invasion
* Sezai Yilmaz [email protected] 1
Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, 244280 Malatya, Turkey
2
Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Elazig Yolu 10. Km, 44280 Malatya, Turkey
Introduction Hepatocellular carcinoma (HCC) is the 5th most common cancer and the second most common cause of cancer death [1]. Only 30 to 40% of the cases are diagnosed at a relatively early stage that is amenable to radical resection or liver transplantation (LT) [2]. However, recurrence is very common especially after surgical resection reaching up to 70–100% [3]. Besides, tumor recurrence following LT is seen 15–20% of the cases despite using diligent selection criteria such as the Milan criteria introduced by Mazzaferro et al. in 1995 [4, 5]. More than 75% of the recurrences occur in the
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