The characteristics of patients with macrovascular invasion in hepatocellular carcinoma: when East meets West

Purpose: To evaluate the prevalence and extension of macrovascular invasion (MaVI) in a large cohort of hepatocellular carcinoma (HCC) patients and analyze the association between MaVI and overall survival (OS). Methods: From 2011 to 2018, 2540 patients with newly diagnosed HCC who were managed in our institution were enrolled in this retrospective study. Tumor invasion of the intrahepatic branches of the portal or hepatic veins was defined as peripheral MaVI. Tumor invasion of the main portal vein or inferior vena cava was defined as central MaVI. Results: MaVI prevalence was 16.2% (n = 411). Among patients with Barcelona Clinic Liver Cancer (BCLC) stage C and Child–Pugh class A, 165 patients presented with peripheral MaVI and 89 patients with central MaVI. The median OS was 13.2 months (95% confidence interval [CI]: 11.4–15.4) in the peripheral MaVI group and 6.6 months (95% CI: 3.6–9.5) in the central MaVI group (p < 0.001). In patients with BCLC stage C and Child–Pugh class B or BCLC stage D, 68 patients presented with peripheral MaVI and 89 patients with central MaVI. The median OS was 3.6 months (95% CI: 3.1–4.2) in the peripheral MaVI group and 2.8 months (95% CI: 2.1–3.4) in the central MaVI group (p = 0.674). Conclusion: The extension of MaVI significantly affected patient survival only in those with BCLC stage C and Child–Pugh class A. In patients with BCLC stage C and Child–Pugh class B or BCLC stage D, survival was poor irrespective of MaVI status.