Preoperative prediction of vessels encapsulating tumor clusters in hepatocellular carcinoma based on CT findings and des-γ-carboxy prothrombin level.

BACKGROUND

Vessels encapsulating tumor clusters (VETC) has been associated with poor prognosis in hepatocellular carcinoma (HCC). However, the preoperative prediction of VETC remains insufficient. We established the VETC predictive score based on CT findings and clinical data in patients with HCC.

METHODS

A total of 209 patients were enrolled, and we investigated clinical features and computed tomography (CT) findings in patients with VETC-positive HCC. The preoperative VETC predictive score was established based on the odds ratios calculated by logistic regression analysis using identified predictive factors, and the accuracy of this score was investigated. The utility of VETC predictive score was validated in the validation cohort.

RESULTS

VETC-positive HCC was associated with higher protein induced by des-γ-carboxy prothrombin (DCP) level (p = 0.03), larger tumor size (p < 0.01), intratumor necrosis (p < 0.01), and intratumor vessels (p < 0.01), and the VETC predictive score was established using these variables. The positive rate of VETC was significantly higher in the score-high group compared to the score-low group (60% vs. 27%, p < 0.01). Patients with high scores showed higher DCP level (p < 0.01), moderate/poor differentiation (p < 0.01), larger tumor (p < 0.01), microvascular invasion (p < 0.01), VETC-positivity (p < 0.01), lower densities of CD8+ cells in center of tumor and invasive margin (p < 0.01, and p < 0.01, respectively), intratumor necrosis (p < 0.01), and intratumor vessels (p < 0.01). In the validation cohort, the high VETC predictive score was associated with VETC-positivity (54% vs. 20%, p < 0.01).

CONCLUSION

The VETC predictive score based on CT and DCP is useful, and preoperative diagnosis of VETC may contribute to optimized treatment management for HCC.