Parameters predicting microvascular invasion and poor differentiation in hepatocellular carcinoma patients with normal AFP level

Aim: The aim of this study is; to evaluate the parameters which might be associated with the pathologically diagnosed microvascular invasion (MİVİ) and poor differentiation, using complete blood count and routine clinical biochemistry tests results, in hepatocellular carcinoma (HCC) patients before liver transplantation. Materials and Methods: The data of the patients who underwent liver transplantation for HCC at Inonu University Liver Transplant Institue, between March 2006 and November 2021 was researched retrospectively. Demographic information of the patients, results of routine hematological and biochemical tests performed before transplantation, the recurrence rate after transplantation, pathological characteristics of primary tumor(maximum tumor diameter, number of nodules, degree of differentiation, presence of microvascular invasion) were recorded. The effects of these variables on the presence of microvascular invasion presence or poor differentiation were statistically analyzed by using univariate and multivariate analyses methods. Findingds: Incidence of microvascular invasion or poor differentiation rate, recurrences after liver transplantation and median recurrence rate, in patients with normal AFP level, were 28.6%, 9.3%, 12.1%, 13 months respectively. After univariate, and multivariate analyzes, Maximum Tumor Diamater (MTD)>4.5cm and number of nodule>5 were found to be independent risk factors for MIVI, and number of nodule>4 and Mean Platelet Volume (MPV)≤8.6 fL were found to be independent risk factors for poor differentiation. The serum AFP levels were still normal at the recurrence time, in the 53% of the patients who had recurrence after liver transplantation, but were elevated in 47% of the recurrence patients. Conclusions: In HCC patients whose AFP level is normal before liver transplantation, independent risk factors of the presence of MİVİ, were, MTD and number of nodules, and independent risk factors of poor differentiation, were, MPV and number of nodules. Furthermore, serum AFP levels of 53% of the HCC patients whose AFP levels were normal before liver transplantation, were normal even at the recurrence time, but serum AFP levels were elevated 47% of the patients at recurrence time.