Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan NanLi, Chaoyang District, Beijing, China.
Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
J Gastrointest Surg. 2019 Dec;23(12):2372-2382. doi: 10.1007/s11605-019-04140-0. Epub 2019 Feb 28.
Microvascular invasion (MVI) relates to poor survival in hepatocellular carcinoma (HCC) patients. In this study, we aim at developing a nomogram for MVI prediction and potential assistance in surgical planning.
A total of 357 patients were assigned to training (n = 257) and validation (n = 100) cohort. Univariate and multivariate analyses were used to reveal preoperative predictors for MVI. A nomogram incorporating independent predictors was constructed and validated. Disease-free survival was compared between patients, and the potential of the predicted MVI in making surgical procedure was also explored.
Pathological examination confirmed MVI in 140 (39.2%) patients. Imaging features including larger tumor, intra-tumoral artery, tumor type, and higher serum AFP independently correlated with MVI. The nomogram showed desirable performance with an AUROC of 0.803 (95% CI, 0.746-0.860) and 0.814 (95% CI, 0.720-0.908) in the training and validation cohorts, respectively. Good calibration were also revealed by calibration curve in both cohorts. The decision curve analysis indicated that the prediction nomogram was of promising usefulness in clinical work. In addition, survival analysis revealed that patients with positive-predicted MVI suffered a higher risk of early recurrence (P < 0.01). There was no difference in disease-free survival between anatomic or non-anatomic resection in large HCC or small HCC without nomogram-predicted MVI. However, anatomic resection improved disease-free survival in small HCC with nomogram-predicted MVI.
The nomogram obtained desirable results in predicting MVI. Patients with predicted MVI were associated with early recurrence and anatomic resection was recommended for small HCC patients with predicted MVI.
微血管侵犯（MVI）与肝细胞癌（HCC）患者的生存不良有关。在这项研究中，我们旨在开发一种用于 MVI 预测的列线图，并为手术规划提供潜在帮助。
共纳入 357 例患者，其中训练队列（n=257）和验证队列（n=100）。采用单因素和多因素分析揭示 MVI 的术前预测因素。构建并验证了包含独立预测因素的列线图。比较了患者之间的无病生存率，并探讨了预测 MVI 在手术决策中的潜在作用。
病理检查证实 140 例（39.2%）患者存在 MVI。影像学特征包括肿瘤较大、肿瘤内动脉、肿瘤类型和血清 AFP 水平较高，均与 MVI 独立相关。列线图在训练队列和验证队列中的 AUC 分别为 0.803（95%CI，0.746-0.860）和 0.814（95%CI，0.720-0.908），具有良好的性能。校准曲线也显示了良好的校准度。决策曲线分析表明，预测列线图在临床工作中有较好的应用价值。此外，生存分析显示，预测 MVI 阳性的患者早期复发风险较高（P<0.01）。在大肝癌或无列线图预测 MVI 的小肝癌中，解剖性或非解剖性切除的无病生存率无差异。然而，在预测 MVI 的小肝癌中，解剖性切除可改善无病生存率。
该列线图在预测 MVI 方面取得了较好的效果。预测 MVI 的患者与早期复发相关，建议对预测 MVI 的小肝癌患者行解剖性切除。
