Endo Yutaka, Alaimo Laura, Lima Henrique A, Moazzam Zorays, Ratti Francesca, Marques Hugo P, Soubrane Olivier, Lam Vincent, Kitago Minoru, Poultsides George A, Popescu Irinel, Alexandrescu Sorin, Martel Guillaume, Workneh Aklile, Guglielmi Alfredo, Hugh Tom, Aldrighetti Luca, Endo Itaru, Pawlik Timothy M
Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, Health Services Management and Policy, James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Department of Surgery, University of Verona, Verona, Italy.
Ann Surg Oncol. 2023 Feb;30(2):725-733. doi: 10.1245/s10434-022-12494-0. Epub 2022 Sep 14.
The presence of microvascular invasion (MVI) has been highlighted as an important determinant of hepatocellular carcinoma (HCC) prognosis. We sought to build and validate a novel model to predict MVI in the preoperative setting.
Patients who underwent curative-intent surgery for HCC between 2000 and 2020 were identified using a multi-institutional database. Preoperative predictive models for MVI were built, validated, and used to develop a web-based calculator.
Among 689 patients, MVI was observed in 323 patients (46.9%). On multivariate analysis in the test cohort, preoperative parameters associated with MVI included α-fetoprotein (AFP; odds ratio [OR] 1.50, 95% confidence interval [CI] 1.23-1.83), imaging tumor burden score (TBS; hazard ratio [HR] 1.11, 95% CI 1.04-1.18), and neutrophil-to-lymphocyte ratio (NLR; OR 1.18, 95% CI 1.03-1.35). An online calculator to predict MVI was developed based on the weighted β-coefficients of these three variables ( https://yutaka-endo.shinyapps.io/MVIrisk/ ). The c-index of the test and validation cohorts was 0.71 and 0.72, respectively. Patients with a high risk of MVI had worse disease-free survival (DFS) and overall survival (OS) compared with low-risk MVI patients (3-year DFS: 33.0% vs. 51.9%, p < 0.001; 5-year OS: 44.2% vs. 64.8%, p < 0.001). DFS was worse among patients who underwent an R1 versus R0 resection among those patients at high risk of MVI (R0 vs. R1 resection: 3-year DFS, 36.3% vs. 16.1%, p = 0.002). In contrast, DFS was comparable among patients at low risk of MVI regardless of margin status (R0 vs. R1 resection: 3-year DFS, 52.9% vs. 47.3%, p = 0.16).
Preoperative assessment of MVI using the online tool demonstrated very good accuracy to predict MVI.
微血管侵犯（MVI）的存在已被视为肝细胞癌（HCC）预后的重要决定因素。我们试图构建并验证一种用于在术前预测MVI的新模型。
利用多机构数据库确定2000年至2020年间接受HCC根治性手术的患者。构建、验证术前MVI预测模型，并用于开发基于网络的计算器。
在689例患者中，323例（46.9%）观察到MVI。在测试队列的多因素分析中，与MVI相关的术前参数包括甲胎蛋白（AFP；比值比[OR]1.50，95%置信区间[CI]1.23 - 1.83）、影像肿瘤负荷评分（TBS；风险比[HR]1.11，95%CI 1.04 - 1.18）和中性粒细胞与淋巴细胞比值（NLR；OR 1.18，95%CI 1.03 - 1.35）。基于这三个变量的加权β系数开发了一个预测MVI的在线计算器（https://yutaka - endo.shinyapps.io/MVIrisk/）。测试队列和验证队列的c指数分别为0.71和0.72。与低风险MVI患者相比，高风险MVI患者的无病生存期（DFS）和总生存期（OS）更差（3年DFS：33.0%对51.9%，p < 0.001；5年OS：44.2%对64.8%，p < 0.001）。在高风险MVI患者中，接受R1切除与R0切除的患者相比，DFS更差（R0与R1切除：3年DFS，36.3%对16.1%，p = 0.002）。相比之下，低风险MVI患者无论切缘状态如何，DFS相当（R0与R1切除：3年DFS，52.9%对47.3%，p = 0.16）。
使用在线工具对MVI进行术前评估显示出预测MVI的准确性非常好。
