Clinical and Molecular Hepatology

"Microvascular invasion"

Letters to the Editor

Classification of microvascular invasion of hepatocellular carcinoma: Different standards, common goals: Letter to the editor on “Classification of microvascular invasion of hepatocellular carcinoma: Correlation with prognosis and magnetic resonance imaging”: Wei Chen, Yihui Rong, Tianshi Ma, Weiwei Shi, Wei Chen, Hang Jiang; Clin Mol Hepatol 2025;31(3):e249-e251.
Published online February 18, 2025; DOI: https://doi.org/10.3350/cmh.2025.0167

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Transcatheter Arterial Chemoembolization May Be Selectively Indicated as Postoperative Adjuvant Therapy for Hepatocellular Carcinoma Patients with Microvascular Invasion
Jie Zeng, Hongyang Huang, Minchao Tang, Zheng Tao, Kaixiang Mo, Weijie Chen, Yuejiao Su, Jinting Su, Rong Liang, Yan Lin, Lequn Li, Guobin Wu, Xiaoling Luo, Jiazhou Ye, Rongyun Mai
Journal of Hepatocellular Carcinoma.2025; Volume 12: 2825. CrossRef

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Hepatic neoplasm

Grading severity of microvascular invasion in hepatocellular carcinoma: More details, more significance: Xiu-Ping Zhang, Fei-Fan Wu, Tian-Chen Zhang, Zhen-Qi Li, Ming-Gen Hu, Rong Liu; Clin Mol Hepatol 2025;31(1):e10-e12.
Published online November 26, 2024; DOI: https://doi.org/10.3350/cmh.2024.0986

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Reply to Correspondence

Hepatic neoplasm

Reply to correspondence on “Severity of microvascular invasion does matter in hepatocellular carcinoma prognosis”: Abdelrahman M Attia, Hasmik Adetyan, Ju Dong Yang; Clin Mol Hepatol 2024;30(4):1042-1043.
Published online August 27, 2024; DOI: https://doi.org/10.3350/cmh.2024.0685

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A clinical study exploring the prediction of microvascular invasion in hepatocellular carcinoma through the use of combined enhanced CT and MRI radiomics
Jiangfa Li, Wenxiang Song, Jixue Li, Lv Cai, Zhao Jiang, Mengxiao Wei, Boming Nong, Meiyu Lai, Yiyi Jiang, Erbo Zhao, Liping Lei, Po-Yao Hsu
PLOS ONE.2025; 20(1): e0318232. CrossRef
Transformer model based on Sonazoid contrast‐enhanced ultrasound for microvascular invasion prediction in hepatocellular carcinoma
Qiong Qin, Jinshu Pang, Jingdan Li, Ruizhi Gao, Rong Wen, Yuquan Wu, Li Liang, Qiao Que, Changwen Liu, Jinbo Peng, Yun Lv, Yun He, Peng Lin, Hong Yang
Medical Physics.2025;[Epub] CrossRef
Correspondence to editorial on “Classification of microvascular invasion of hepatocellular carcinoma: correlation with prognosis and magnetic resonance imaging”
Haeryoung Kim, Dong Ho Lee, Yoon Jung Hwang
Clinical and Molecular Hepatology.2024; 30(4): 992. CrossRef

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Correspondence

Hepatic neoplasm

Correspondence to editorial on “Classification of microvascular invasion of hepatocellular carcinoma: correlation with prognosis and magnetic resonance imaging”: Haeryoung Kim, Dong Ho Lee, Yoon Jung Hwang; Clin Mol Hepatol 2024;30(4):992-993.
Published online August 5, 2024; DOI: https://doi.org/10.3350/cmh.2024.0624

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Reply to correspondence on “Severity of microvascular invasion does matter in hepatocellular carcinoma prognosis”
Abdelrahman M Attia, Hasmik Adetyan, Ju Dong Yang
Clinical and Molecular Hepatology.2024; 30(4): 1042. CrossRef

4,757 View
47 Download
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Editorial

Hepatic neoplasm

Severity of microvascular invasion does matter in hepatocellular carcinoma prognosis: Editorial on “Classification of microvascular invasion of hepatocellular carcinoma: correlation with prognosis and magnetic resonance imaging”: Abdelrahman M Attia, Hasmik Adetyan, Ju Dong Yang; Clin Mol Hepatol 2024;30(4):653-655.
Published online July 1, 2024; DOI: https://doi.org/10.3350/cmh.2024.0482

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Transformer model based on Sonazoid contrast‐enhanced ultrasound for microvascular invasion prediction in hepatocellular carcinoma
Qiong Qin, Jinshu Pang, Jingdan Li, Ruizhi Gao, Rong Wen, Yuquan Wu, Li Liang, Qiao Que, Changwen Liu, Jinbo Peng, Yun Lv, Yun He, Peng Lin, Hong Yang
Medical Physics.2025;[Epub] CrossRef

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Original Articles

Hepatic neoplasm

Classification of microvascular invasion of hepatocellular carcinoma: correlation with prognosis and magnetic resonance imaging: Yoon Jung Hwang, Jae Seok Bae, Youngeun Lee, Bo Yun Hur, Dong Ho Lee, Haeryoung Kim; Clin Mol Hepatol 2023;29(3):733-746.
Published online May 8, 2023; DOI: https://doi.org/10.3350/cmh.2023.0034

Background/Aims
The microvascular invasion (MVI) of hepatocellular carcinoma (HCC) involves a wide histological spectrum, and it is unclear whether the degree of MVI correlates with patient prognosis or imaging findings. Here, we evaluate the prognostic value of MVI classification and analyze the radiologic features predictive of MVI.
Methods
Using a retrospective cohort of 506 patients with resected solitary HCCs, the histological and imaging features of MVI were reviewed and correlated with clinical data.
Result
s: MVI-positive HCCs invading ≥5 vessels or those with ≥50 invaded tumor cells were significantly associated with decreased overall survival (OS). The 5-year OS, recurrence-free survival (RFS), and beyond Milan criteria RFS rates were significantly poorer in patients with severe MVI compared with those with mild or no MVI. Severe MVI was a significant independent predictive factor for OS (odds ratio [OR], 2.962; p<0.001), RFS (OR, 1.638; p=0.002), and beyond Milan criteria RFS (OR, 2.797; p<0.001) on multivariable analysis. On MRI, non-smooth tumor margins (OR, 2.224; p=0.023) and satellite nodules (OR, 3.264; p<0.001) were independently associated with the severe-MVI group on multivariable analysis. Both non-smooth tumor margins and satellite nodules were associated with worse 5-year OS, RFS, and beyond Milan criteria RFS.
Conclusions
Histologic risk classification of MVI according to the number of invaded microvessels and invading carcinoma cells was a valuable predictor of prognosis in HCC patients. Non-smooth tumor margin and satellite nodules were significantly associated with severe MVI and poor prognosis.

Citations

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Integrating multiphase MRI surrogates to improve microvascular invasion detection and recurrence risk stratification in HCC
Fan Li, Ruishan Liu, Jin-ming Cao, Ping Lin, Xu Feng, Yangyang Xie, Ye Xiang, Hong-wei Li, Jin Zhang, Haibo Qu, Gang Ning, Lihua Zhuo
JHEP Reports.2026; 8(2): 101682. CrossRef
Gadoxetic Acid–enhanced MRI Radiomics Features of Tumor Margins for Predicting High-Risk Solitary Hepatocellular Carcinoma Aggressiveness and Prognosis
Can Yu, Xinxin Wang, Shuli Tang, Yan Li, Shuai Han, Qiuju Zhang, Jinrong Qu, Haitao Xu, Yang Zhou
Radiology: Imaging Cancer.2026;[Epub] CrossRef
Alpha-fetoprotein combined with initial tumor shape irregularity in predicting the survival of patients with advanced hepatocellular carcinoma treated with immune-checkpoint inhibitors: a retrospective multi-center cohort study
Feng Zhang, Yong-Shuai Wang, Shao-Peng Li, Bin Zhao, Nan Huang, Rui-Peng Song, Fan-Zheng Meng, Zhi-Wen Feng, Shen-Yu Zhang, Hua-Chuan Song, Xiao-Peng Chen, Lian-Xin Liu, Ji-Zhou Wang
Journal of Gastroenterology.2025; 60(4): 442. CrossRef
Grading severity of microvascular invasion in hepatocellular carcinoma: More details, more significance
Xiu-Ping Zhang, Fei-Fan Wu, Tian-Chen Zhang, Zhen-Qi Li, Ming-Gen Hu, Rong Liu
Clinical and Molecular Hepatology.2025; 31(1): e10. CrossRef
Development of a prognostic model for hepatocellular carcinoma based on microvascular invasion characteristic genes by spatial transcriptomics sequencing
Xiaolan Mu, Lili Pan, Xicheng Wang, Changcheng Liu, Yu Li, Yongchao Cai, Zhiying He
Frontiers in Immunology.2025;[Epub] CrossRef
Predicting microvascular invasion in solitary hepatocellular carcinoma: a multi-center study integrating clinical, MRI assessments, and radiomics indicators
Wang Jian, Lin Zhan, Lin Zhaowang, Yang Ling, Yu Min, Xie Rong, Lin Wanxing, Yang Yongfei, Tu Haibin
Frontiers in Oncology.2025;[Epub] CrossRef
Histone lactylation drives liver cancer metastasis by facilitating NSF1-mediated ferroptosis resistance after microwave ablation
Jiayan Huang, Huijing Xie, Ju Li, Xiaotong Huang, Yunshi Cai, Rui Yang, Dongmei Yang, Wuyongga Bao, Yongjie Zhou, Tao Li, Qiang Lu
Redox Biology.2025; 81: 103553. CrossRef
A novel nomogram based on complement C3 to predict the overall survival of early-stage hepatocellular carcinoma patients with microvascular invasion-positive undergoing curative resection
Guoyi Xia, Zeyan Yu, Shaolong Lu, Xiaobo Wang, Yuanquan Zhao, Jie Chen
Frontiers in Oncology.2025;[Epub] CrossRef
Association Between Viral Replication Activity and Postoperative Recurrence of HBV‐Related Hepatocellular Carcinoma
Subin Heo, Jiwon Yang, Jeayeon Park, Rex Wan‐Hin Hui, Byeong Geun Song, In‐Hye Song, Young‐In Yoon, Tan‐To Cheung, Sung Won Chung, Jonggi Choi, Danbi Lee, Ju Hyun Shim, Kang Mo Kim, Young‐Suk Lim, Han Chu Lee, Wai‐Kay Seto, Jeong‐Hoon Lee, Won‐Mook Choi
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Yoon Jung Hwang, Hyejung Lee, Suk Kyun Hong, Su Jong Yu, Haeryoung Kim
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Zhu Zhu, Kaiying Wu, Jian Lu, Sunxian Dai, Dabo Xu, Wei Fang, Yixing Yu, Wenhao Gu
BMC Medical Imaging.2025;[Epub] CrossRef
Evaluating the severity of microvascular invasion in hepatocellular carcinoma, by probing the combination of enhancement modes and growth patterns through magnetic resonance imaging
Yanzhuo Li, Sijie Li, Yan Lei, Lianlian Liu, Bin Song
Radiology and Oncology.2025; 59(2): 183. CrossRef
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Ja Kyung Yoon, Jin-Young Choi
Journal of the Korean Society of Radiology.2025; 86(3): 364. CrossRef
Adjuvant Transarterial Chemoembolization After Truly Curative Resection Does Not Improve Survival of Patients With Hepatocellular Carcinoma at High Risk of Recurrence: A Target Trial Emulation Study
Jia‐Yong Su, De‐Jia Huang, Shao‐Ping Liu, Xiao‐Ling Xu, Shu‐Chang Chen, Jun‐Jie Ou, Jian‐Rong Li, Tai‐Xin Yang, Wen‐Yang Li, Yuan Fan, Zhao‐Chan Wen, Le Chen, Zhen Qin, Bei‐Bei Long, Da‐Zhi Li, Jiang‐Hong Huang, Yi‐Jia Lu, Jun‐Chi Zhong, Hai‐Qiang Zhu, Li
Hepatology Research.2025; 55(9): 1263. CrossRef
Classification of microvascular invasion of hepatocellular carcinoma: Different standards, common goals: Letter to the editor on “Classification of microvascular invasion of hepatocellular carcinoma: Correlation with prognosis and magnetic resonance imagi
Wei Chen, Yihui Rong, Tianshi Ma, Weiwei Shi, Wei Chen, Hang Jiang
Clinical and Molecular Hepatology.2025; 31(3): e249. CrossRef
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Yong-Yi Cen, Hai-Yang Nong, Xiao-Xiao Huang, Xiu-Xian Lu, Chang-Hong Pu, Li-Hong Huang, Xiao-Jun Zheng, Zhao-Lin Pan, Yin Huang, Ke Ding, De-You Huang
World Journal of Gastroenterology.2025;[Epub] CrossRef
Deep Learning-Based Prediction of Microvascular Invasion and Survival Outcomes in Hepatocellular Carcinoma Using Dual-phase CT Imaging of Tumors and Lesser Omental Adipose: A Multicenter Study
Shidi Miao, Mengzhuo Sun, Xuemeng Li, Mingxuan Wang, Yuyang Jiang, Zengyao Liu, Qiujun Wang, Xuemei Ding, Ruitao Wang
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Integrating intratumoral, peritumoral, and clinical features in an ultrasound-based radiomics model: contributions and synergies for predicting microvascular invasion in hepatocellular carcinoma
Hong Fu, Yanhua Huang, Baochun Lu, Jianhua Yu, Difan Zhou, Chuanling Hou, Luohang Xu, Hongwei Qian
Frontiers in Oncology.2025;[Epub] CrossRef
Limited survival benefit of preoperative transarterial chemoembolization in huge hepatocellular carcinoma due to the prognostic impact of satellite nodules: a retrospective cohort study
Byeong-Gon Na, Shin Hwang, Chul-Soo Ahn, Ki-Hun Kim, Deok-Bog Moon, Tae-Yong Ha, Gi-Won Song, Dong-Hwan Jung, Gil-Chun Park, Sang Hoon Kim, Sung-Gyu Lee
Annals of Surgical Treatment and Research.2025; 109(3): 194. CrossRef
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Jinlong Huo, Youming Guo, Yan Wu, Wei Liu
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Xiaoli Zou, Danyi Zhao, Yu Shang, Yu Song, Yimei Deng, Lin Lu
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Zhi-Hong Zhang, Chuang Jiang, Ze-Yuan Qiang, Yi-Fan Zhou, Jun Ji, Yong Zeng, Ji-Wei Huang
Asian Journal of Surgery.2024; 47(5): 2138. CrossRef
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Feng Liu, Tinghua Yan, Dan Cui, Jinhua Jiang
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Shuaishuai Xu, Mingyu Wan, Chanqi Ye, Ruyin Chen, Qiong Li, Xiaochen Zhang, Jian Ruan
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Korean Journal of Radiology.2024; 25(10): 887. CrossRef
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Abdelrahman M Attia, Hasmik Adetyan, Ju Dong Yang
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Severity of microvascular invasion does matter in hepatocellular carcinoma prognosis: Editorial on “Classification of microvascular invasion of hepatocellular carcinoma: correlation with prognosis and magnetic resonance imaging”
Abdelrahman M Attia, Hasmik Adetyan, Ju Dong Yang
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Haeryoung Kim, Dong Ho Lee, Yoon Jung Hwang
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Impact of immunosuppressant therapy on early recurrence of hepatocellular carcinoma after liver transplantation: Ju-Yeun Lee, Yul Hee Kim, Nam-Joon Yi, Hyang Sook Kim, Hye Suk Lee, Byung Koo Lee, Hyeyoung Kim, Young Rok Choi, Geun Hong, Kwang-Woong Lee, Kyung-Suk Suh; Clin Mol Hepatol 2014;20(2):192-203.
Published online June 30, 2014; DOI: https://doi.org/10.3350/cmh.2014.20.2.192

Abstract
PDF

Background/Aims

The most commonly used immunosuppressant therapy after liver transplantation (LT) is a combination of tacrolimus and steroid. Basiliximab induction has recently been introduced; however, the most appropriate immunosuppression for hepatocellular carcinoma (HCC) patients after LT is still debated.

Methods

Ninety-three LT recipients with HCC who took tacrolimus and steroids as major immunosuppressants were included. Induction with basiliximab was implemented in 43 patients (46.2%). Mycophenolate mofetil (MMF) was added to reduce the tacrolimus dosage (n=28, 30.1%). The 1-year tacrolimus exposure level was 7.2 ± 1.3 ng/mL (mean ± SD).

Results

The 1- and 3-year recurrence rates of HCC were 12.9% and 19.4%, respectively. Tacrolimus exposure, cumulative steroid dosages, and MMF dosages had no impact on HCC recurrence. Induction therapy with basiliximab, high alpha fetoprotein (AFP; >400 ng/mL) and protein induced by vitamin K absence/antagonist-II (PIVKA-II; >100 mAU/mL) levels, and microvascular invasion were significant risk factors for 1-year recurrence (P<0.05). High AFP and PIVKA-II levels, and positive ¹⁸fluoro-2-deoxy-d-glucose positron-emission tomography findings were significantly associated with 3-year recurrence (P<0.05).

Conclusions

Induction therapy with basiliximab, a strong immunosuppressant, may have a negative impact with respect to early HCC recurrence (i.e., within 1 year) in high-risk patients.

Citations

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Correlation of p53 Mutations and Microvascular Invasions of Hepatocellular Carcinoma: A Possible Factor of Poor Prognosis Following Surgical Resection: Kwang Hee Youn, M.D., Young-Hwa Chung, M.D., Soohyun Yang, M.D., Byung-Cheol Song, M.D., In Ran Hong, Jung A Kim, Yung Sang Lee, M.D., Dong Jin Suh, M.D., Eunsil Yu, M.D.1, Young-Joo Lee, M.D.2, Sung Gyu Lee, M.D.2; Korean J Hepatol 1999;5(2):124-135.

Abstract
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Background/Aims
: p53 mutations have been reported to be a poor prognostic indicator in patients with HCC treated by surgical resection because of the association with frequent recurrence and shorter survival periods. Although poor differentiation of tumor has been considered to be associated with p53 mutation more frequently, the exact causes of unfavorable prognosis have not been clarified. Methods : To evaluate the relationship of p53 mutation and details of histological features, we examined 20 HCCs and surrounding liver tissues from the patients treated with surgical resection using direct sequencing of p53 gene at exons 5, 6, 7 and 8, and analyzed histopathologic features. We also analyzed the clinical, biochemical and radiological characteristics including the recurrences of tumor and survival periods in HCC patients with p53 mutant comparing to those with wild type p53 gene. Results : p53 mutants were found in 9 (45%) out of 20 resected HCC tissues, none from any surrounding tissues. p53 mutations were all point substitutions of a base; 5 in exon 8, 4 in exon 5 and 1 in exon 7. Between patients with mutants and those with wild type of p53 gene, there were no differences in age, sex, serum ALT, albumin, bilirubin and AFP levels, and HBV-positivity. HCCs with p53 mutants tended to be larger in size (14% in < 5 cm vs 67 % in > 5 cm; p=0.03) and multinodular in type (3/9 vs 0/11; p=0.07). p53 mutants tended to be found in poorly differentiated HCCs comparing to wild types. Even though there was no evidence of vascular or biliary invasion radiologically in all, 5 of 9 p53 mutant (+) (56%) and none of 11 p53-mutant (-) cases showed vascular invasions microscopically (p<0.01). However, there was no correlation between p53 mutations in tumor tissues and formation of capsules, biliary invasions or association with cirrhosis. During follow-up periods (median: 22;2 -28 mos) recurrences of HCC had been found in 6 of 9 patients with mutants (67%) in contrast to only 2 of 11 with wild types (18%)(p=0.07). Extrahepatic metastases were also common in patients with p53 mutant than those without it (56% vs 9%; p=0.05). Consequently, the 1 year cancer free survival rate of HCC patients with p53 mutant was significantly lower than that with wild type (44% vs 82%; p=0.02). Conclusions : Thus, it is suggested that p53 mutations tend to be commonly associated with microvascular invasions as well as poor differentiation microscopically, which may result in micrometastasis and frequent recurrences, and consequently shorter survival periods in HCC patents undergoing surgical resection. (Korean J Hepatol 1999;5:124－135)