Vessels that encapsulate tumour clusters vascular pattern in hepatocellular carcinomaKey points
Ken Liu,
Claude Dennis,
David S. Prince,
Felix Marsh-Wakefield,
Cositha Santhakumar,
Jennifer R. Gamble,
Simone I. Strasser,
Geoffrey W. McCaughan
Affiliations
Ken Liu
Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Liver Injury and Cancer Program, Centenary Institute, Sydney, NSW, Australia; Corresponding author. Address: AW Morrow Gastroenterology and Liver Centre, Level 9, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia; Tel.: +61 2 9515 8578, fax: +61 2 9515 5182.
Claude Dennis
Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia
David S. Prince
Department of Gastroenterology, Liverpool Hospital, Sydney, NSW, Australia
Felix Marsh-Wakefield
Liver Injury and Cancer Program, Centenary Institute, Sydney, NSW, Australia; Human Immunology Laboratory, The University of Sydney, Sydney, NSW, Australia
Cositha Santhakumar
Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Liver Injury and Cancer Program, Centenary Institute, Sydney, NSW, Australia; Human Immunology Laboratory, The University of Sydney, Sydney, NSW, Australia
Jennifer R. Gamble
Centre for Endothelium, Vascular Biology Program, Centenary Institute, Sydney, NSW, Australia
Simone I. Strasser
Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
Geoffrey W. McCaughan
Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Liver Injury and Cancer Program, Centenary Institute, Sydney, NSW, Australia
Summary: Vessels that encapsulate tumour clusters (VETC) is a distinct histologic vascular pattern associated with a novel mechanism of metastasis. First described in human cancers in 2004, its prevalence and prognostic significance in hepatocellular carcinoma (HCC) has only been appreciated in the past decade with a rapidly increasing body of literature. A robust biomarker of aggressive disease, the VETC pattern is easy to recognise but relies on histologic examination of tumour tissue for its diagnosis. Radiological recognition of the VETC pattern is an area of active research and is becoming increasingly accurate. As a prognostic marker, VETC has consistently proven to be an independent predictor of disease recurrence and overall survival in patients with HCC undergoing resection and liver transplantation. It can also guide treatment by predicting response to other therapies such as transarterial chemoembolisation and sorafenib. Without prospective randomised-controlled trials or routine evaluation of VETC in clinical practice, there are currently no firm treatment recommendations for VETC-positive tumours, although some perspectives are provided in this review based on the latest knowledge of their pathogenesis – a complex interplay between tumour angiogenesis and the immune microenvironment. Nevertheless, VETC has great potential as a future biomarker that could take us one step closer to precision medicine for HCC.
