Guo Q Q, Ma X H, Han R C, Zhao X M
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 100021, China.
Department of Diagnostic Radiology, Guizhou Provincial People's Hospital, Guiyang 550002, China.
Zhonghua Zhong Liu Za Zhi. 2023 Aug 23;45(8):666-672. doi: 10.3760/cma.j.cn112152-20211101-00803.
To investigate the risk factors of microvascular invasion (MVI) in China liver cancer staging system stage Ⅰa (CNLC Ⅰa) hepatocellular carcinoma (HCC), and develop a nomogram for predicting MVI based on clinical and radiographic data. This retrospective study focused on CNLC Ⅰa HCC patients who underwent radical resection at the Cancer Hospital, Chinese Academy of Medical Sciences from January 2016 to December 2020. Patients' clinical characteristics and laboratory test results and pre-surgery gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging results were collected. The clinical and radiographic risk factors for MVI were identified by univariate and multivariate logistic regression analyses and used for the construction of the predictive nomogram. The nomogram model was then internally validated, and its performance was assessed. A total of 104 patients were divided into the MVI-positive group (=28) and the MVI-negative group (=76). Multivariate logistic regression analysis at the <0.1 level identified serum alpha-ferroprotein >7 ng/ml, total bilirubin >21 μmol/L, prothrombin time >12.5 s, non-smooth margin, and incomplete or absent capsule as risk factors of MVI, based on which a nomogram model was built. The model achieved an area under the curve (AUC) value of 0.867 (95% confidence interval, 0.791-0.944) in the internal validation. The sensitivity and specificity of the nomogram model were 0.786 and 0.829, respectively, with the prediction curve nearly overlapping the ideal curve. Based on the Hosmer-Lemeshow test, the predicted and real results were not significantly different (=0.956). The probability of MVI of CNLC Ⅰa HCC can be objectively predicted by the monogram model that quantifies the clinical and radiographic risk factors. The model can also help clinicians select individualized surgical plans to improve the long-term prognosis of patients.
为探讨中国肝癌分期系统Ⅰa期(CNLCⅠa)肝细胞癌(HCC)微血管侵犯(MVI)的危险因素,并基于临床和影像学数据制定预测MVI的列线图。本回顾性研究聚焦于2016年1月至2020年12月在中国医学科学院肿瘤医院接受根治性切除术的CNLCⅠa期HCC患者。收集患者的临床特征、实验室检查结果及术前钆塞酸二钠(Gd-EOB-DTPA)增强磁共振成像结果。通过单因素和多因素逻辑回归分析确定MVI的临床和影像学危险因素,并用于构建预测列线图。然后对列线图模型进行内部验证,并评估其性能。共104例患者分为MVI阳性组(=28)和MVI阴性组(=76)。在<0.1水平的多因素逻辑回归分析确定血清甲胎蛋白>7 ng/ml、总胆红素>21 μmol/L、凝血酶原时间>12.5 s、边缘不光滑以及包膜不完整或缺失为MVI的危险因素,并据此建立列线图模型。该模型在内部验证中的曲线下面积(AUC)值为0.867(95%置信区间,0.791-0.944)。列线图模型的敏感性和特异性分别为0.786和0.829,预测曲线几乎与理想曲线重叠。基于Hosmer-Lemeshow检验,预测结果与实际结果无显著差异(=0.956)。通过量化临床和影像学危险因素的列线图模型可客观预测CNLCⅠa期HCC的MVI概率。该模型还可帮助临床医生选择个体化手术方案,以改善患者的长期预后。