The importance of a nonsmooth tumor margin and incomplete tumor capsule in predicting HCC microvascular invasion on preoperative imaging examination: a systematic review and meta-analysis

Abstract

Objectives

Microvascular invasion (MVI) is a key factor affecting the prognosis of hepatocellular carcinoma (HCC). Preoperative imaging plays an important role in the diagnosis of HCC, treatment planning and treatment evaluation, but it is still difficult to detect MVI directly. Whether the appearance of the tumor margin and the capsule on radiological images can predict MVI is still controversial. The aim of this study is to explore the correlation of the presence of MVI with the smoothness of the tumor margin and the integrity of the capsule in HCC.

Materials and methods

The PubMed, Embase, Medline, SCI and Cochrane Library databases up to January 2020. Heterogeneity among studies was assessed by sensitivity analysis, subgroup analysis and meta-regression, and the influence of threshold effects was also analyzed.

Results

Eleven studies with 1618 patients were included. The results of the meta-analysis indicated that there was a significant relationship between MVI and nonsmooth tumor margin (DOR = 4.62 [2.73, 7.81]) and between MVI and incomplete tumor capsule (DOR = 2.25 [1.22, 4.15]); the sensitivity and specificity of these two parameters were 0.757 [0.602, 0.865], 0.597 [0.450, 0.728] and 0.646 [0.455, 0.800], 0.552 [0.419, 0.678], respectively. We drew the receiver operating characteristic (ROC) curves, and the area under curve (AUC) of the nonsmooth tumor margin variable for predicting MVI was 0.72 [0.69, 0.77], and the AUC of the incomplete tumor capsule variable for predicting MVI was 0.62 [0.58, 0.66].

Conclusion

Nonsmooth tumor margins and incomplete tumor capsules observed by imaging are important for the preoperative prediction of MVI in HCC.