一种结合血液学和影像学特征的列线图在肝细胞癌患者微血管侵犯术前预测中的开发与验证

Development and validation of a nomogram combining hematological and imaging features for preoperative prediction of microvascular invasion in hepatocellular carcinoma patients.

作者信息

Zhou Qiang, Zhou Chenhao, Yin Yirui, Chen Wanyong, Liu Chunxiao, Atyah Manar, Weng Jialei, Shen Yinghao, Yi Yong, Ren Ning

机构信息

Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, and Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University, Shanghai, China.

Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.

出版信息

Ann Transl Med. 2021 Mar;9(5):402. doi: 10.21037/atm-20-4695.

DOI:10.21037/atm-20-4695

PMID:33842623

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8033313/

Abstract

BACKGROUND

Microvascular invasion (MVI) is a significant hazard factor that influences the recurrence and survival of hepatocellular carcinoma (HCC) patients after undergoing hepatectomy. This study aimed to develop and validate a nomogram that combines hematological and imaging features of HCC patients to preoperatively predict MVI, and investigate the effect of wide resection margin (≥1 cm) on the prognosis of MVI-positive HCC patients.

METHODS

A total of 709 HCC patients who underwent hepatectomy at the Liver Cancer Institute of Zhongshan Hospital, Fudan University between June 1, 2015 and December 30, 2016 were included in this study and divided into training (496 patients) and validation cohort (213 patients). Least absolute shrinkage and selection operator (Lasso) regression and multivariable logistic regression were used for variables' selection and development of the predictive model. The model was presented as a nomogram, and its performance was assessed in terms of discrimination, calibration and clinical usefulness.

RESULTS

Independent prognostic factors such as alkaline phosphatase (ALP, >125 U/L), alpha-fetoprotein (AFP, within 20-400 or >400 ng/mL), protein induced by vitamin K absence-II (PVIKA-II, within 40-400 or >400 mAU/mL), tumor number, diameter, pseudo-capsule, tumor growth pattern and intratumor hemorrhage were incorporated in the nomogram. The model showed good discrimination and calibration, with a concordance index (0.82, 95% CI, 0.782-0.857) in the training cohort and C-index (0.80, 95% CI, 0.772-0.837) in the validation cohort. Decision curve analysis (DCA) also showed that this model is clinically useful. Moreover, HCC patients with wide resection margin had a significantly lower 3-year recurrence rate than those with narrower resection margin (0.5-1 cm).

CONCLUSIONS

This study presents an optimal model for preoperative prediction of MVI and shows that wide resection margin for MVI-positive HCC patients has a better prognosis. This model can help surgeons choose the best treatment options for HCC patients before and after the operation.

摘要

背景

微血管侵犯（MVI）是影响肝细胞癌（HCC）患者肝切除术后复发和生存的重要危险因素。本研究旨在建立并验证一种结合HCC患者血液学和影像学特征的列线图，以术前预测MVI，并探讨宽切缘（≥1 cm）对MVI阳性HCC患者预后的影响。

方法

本研究纳入了2015年6月1日至2016年12月30日在复旦大学附属中山医院肝癌研究所接受肝切除术的709例HCC患者，并将其分为训练队列（496例患者）和验证队列（213例患者）。采用最小绝对收缩和选择算子（Lasso）回归及多变量逻辑回归进行变量选择和预测模型的构建。该模型以列线图形式呈现，并从区分度、校准度和临床实用性方面评估其性能。

结果

碱性磷酸酶（ALP，＞125 U/L）、甲胎蛋白（AFP，20 - 400或＞400 ng/mL）、维生素K缺乏诱导蛋白-II（PVIKA-II，40 - 400或＞400 mAU/mL）、肿瘤数量、直径、假包膜、肿瘤生长方式和瘤内出血等独立预后因素被纳入列线图。该模型显示出良好的区分度和校准度，训练队列中的一致性指数为0.82（95% CI，0.782 - 0.857），验证队列中的C指数为0.80（95% CI，0.772 - 0.837）。决策曲线分析（DCA）也表明该模型具有临床实用性。此外，宽切缘的HCC患者3年复发率显著低于窄切缘（0.5 - 1 cm）的患者。