Effect of microvascular invasion on survival and prognosis of liver transplantation recipients with liver cancer

doi:10.3877/cma.j.issn.2095-3232.2023.06.007

Abstract

Abstract:

Objective

To evaluate the effect of microvascular invasion (MVI) on the postoperative prognosis of liver transplantation recipients with liver cancer.

Methods

Clinical data of 78 patients with liver cancer who underwent liver transplantation in the First People's Hospital of Foshan from January 2011 to December 2021 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 71 patients were male and 7 female, aged (53±9) years on average. 72 cases were positive for HBsAg. Child-Pugh score was 8±2 and the model for end-stage liver disease (MELD) score was 14±7. All patients were divided into the positive (n=19) and negative MVI groups (n=59) according to postoperative pathological results. Postoperative survival of patients was compared between two groups. Survival analysis was assessed by Kaplan-Meier method and Log-rank test. The factors affecting postoperative survival were analyzed by Cox proportional hazard regression model.

Results

The postoperative 1-, 3- and 5-year overall survival (OS) in the positive MVI group was 89.5%, 68.6% and 58.8%, significantly lower than 94.5%, 89.8% and 86.0% in the negative MVI group (χ²=5.495, P<0.05). In the positive MVI group, the postoperative 1-, 3- and 5-year progression-free survival (PFS) was 79.0%, 60.3% and 51.7%, significantly lower than 92.6%, 85.5% and 76.0% in the negative MVI group (χ²=3.960, P<0.05). Cox multivariate analysis showed that patients' age, Child-Pugh score, number of tumors and positive MVI were the independent influencing factors of postoperative OS (OR=0.068, 14.861, 50.102, 3.201; P<0.05). The tumor diameter and positive MVI were the independent influencing factors of postoperative PFS (OR=2.150, 2.333; P<0.05). For patients who met Milan criteria, postoperative OS and PFS in the MVI positive group were also significantly worse than those in the negative MVI group (χ²=6.013, 6.595; P<0.05).

Conclusions

Positive MVI is an independent influencing factor of postoperative survival of liver cancer patients after liver transplantation. Patients positive for MVI have higher recurrence rate and worse survival compared with their negative counterparts.

Key words: Carcinoma, hepatocellular, Microvascular invasion, Liver transplantation

Qing Yan, Ying Liu, Feiwen Deng, Huanwei Chen. Effect of microvascular invasion on survival and prognosis of liver transplantation recipients with liver cancer[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2023, 12(06): 624-629.

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References 29

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组别	例数	年龄(岁，±s)	性别(例)		AFP>400 μg/L(例)	HBsAg阳性(例)	Child-Pugh评分(分，±s)	MELD评分(分，±s)	肿瘤直径[cm，±s]	单发病灶(例)	AJCC分期Ⅲ~Ⅳ期(例)
组别	例数	年龄(岁，±s)	男	女	AFP>400 μg/L(例)	HBsAg阳性(例)	Child-Pugh评分(分，±s)	MELD评分(分，±s)	肿瘤直径[cm，±s]	单发病灶(例)	AJCC分期Ⅲ~Ⅳ期(例)
MVI阳性	19	51±8	19	0	7	18	8.4±2.5	14±8	5.9±4.2	8	8
MVI阴性	59	54±9	52	7	8	54	7.9±2.3	14±7	3.7±2.8	34	6
统计值		t=-1.171	-		χ²=5.016	χ²=0.209	t=0.796	t=0.374	t=2.607	χ²=1.393	χ²=9.953
P值		0.245	0.185		0.025	0.648	0.428	0.710	0.011	0.238	0.002

组别	例数	年龄(岁，±s)	性别(例)		AFP>400 μg/L(例)	HBsAg阳性(例)	Child-Pugh评分(分，±s)	MELD评分(分，±s)	肿瘤直径[cm，±s]	单发病灶(例)	AJCC分期Ⅲ~Ⅳ期(例)
组别	例数	年龄(岁，±s)	男	女	AFP>400 μg/L(例)	HBsAg阳性(例)	Child-Pugh评分(分，±s)	MELD评分(分，±s)	肿瘤直径[cm，±s]	单发病灶(例)	AJCC分期Ⅲ~Ⅳ期(例)
MVI阳性	19	51±8	19	0	7	18	8.4±2.5	14±8	5.9±4.2	8	8
MVI阴性	59	54±9	52	7	8	54	7.9±2.3	14±7	3.7±2.8	34	6
统计值		t=-1.171	-		χ²=5.016	χ²=0.209	t=0.796	t=0.374	t=2.607	χ²=1.393	χ²=9.953
P值		0.245	0.185		0.025	0.648	0.428	0.710	0.011	0.238	0.002

指标	单因素分析			多因素分析
指标	OR	95%CI	P值	OR	95%CI	P值
年龄	0.561	0.187~1.681	0.302	0.068	0.009~0.532	0.010
男性	0.846	0.109~6.600	0.874	11.504	0.926~142.956	0.057
AFP>400 μg/L	4.753	1.531~14.756	0.007	1.518	0.397~5.801	0.542
HBsAg阳性	27.756	0.010~39.068	0.409	16.036	0.001~47.417	0.989
Child-Pugh评分	2.542	1.153~5.606	0.021	14.861	2.404~91.882	0.004
MELD评分	3.536	1.046~11.960	0.042	0.470	0.047~4.733	0.522
移植前治疗	1.133	0.379~3.390	0.823	1.281	0.273~6.017	0.754
肿瘤直径	3.621	1.179~11.124	0.025	1.860	0.417~8.293	0.416
肿瘤多发	7.261	1.608~32.792	0.010	50.102	3.639~689.731	0.003
AJCC Ⅲ~Ⅳ期	6.310	2.107~18.897	0.001	0.541	0.068~4.301	0.561
MVI阳性	3.433	1.148~10.271	0.027	3.201	1.652~15.717	0.015

指标	单因素分析			多因素分析
指标	OR	95%CI	P值	OR	95%CI	P值
年龄	0.561	0.187~1.681	0.302	0.068	0.009~0.532	0.010
男性	0.846	0.109~6.600	0.874	11.504	0.926~142.956	0.057
AFP>400 μg/L	4.753	1.531~14.756	0.007	1.518	0.397~5.801	0.542
HBsAg阳性	27.756	0.010~39.068	0.409	16.036	0.001~47.417	0.989
Child-Pugh评分	2.542	1.153~5.606	0.021	14.861	2.404~91.882	0.004
MELD评分	3.536	1.046~11.960	0.042	0.470	0.047~4.733	0.522
移植前治疗	1.133	0.379~3.390	0.823	1.281	0.273~6.017	0.754
肿瘤直径	3.621	1.179~11.124	0.025	1.860	0.417~8.293	0.416
肿瘤多发	7.261	1.608~32.792	0.010	50.102	3.639~689.731	0.003
AJCC Ⅲ~Ⅳ期	6.310	2.107~18.897	0.001	0.541	0.068~4.301	0.561
MVI阳性	3.433	1.148~10.271	0.027	3.201	1.652~15.717	0.015

指标	单因素分析			多因素分析
指标	OR	95%CI	P值	OR	95%CI	P值
年龄	0.985	0.934~1.039	0.580	0.982	0.914~1.055	0.619
男性	1.683	0.383~7.397	0.491	3.040	0.427~21.675	0.267
AFP>400 μg/L	3.768	1.429~9.937	0.007	2.386	0.671~8.480	0.179
HBsAg阳性	23.239	0.014~38.620	0.406	13.632	0.162~25.360	0.563
Child-Pugh评分	1.074	0.880~1.311	0.484	0.744	0.495~1.117	0.154
MELD评分	1.045	0.989~1.105	0.119	1.080	0.915~1.274	0.363
移植前治疗	1.415	0.538~3.722	0.482	1.928	0.583~6.378	0.282
肿瘤直径	1.229	1.099~1.375	<0.001	2.150	1.021~3.294	0.021
肿瘤多发	3.130	1.101~8.895	0.032	1.933	0.384~9.727	0.424
AJCCⅢ~Ⅳ期	5.079	1.949~13.237	0.001	2.648	0.456~15.365	0.278
MVI阳性	2.761	1.065~7.163	0.037	2.333	1.340~5.225	0.036

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