Chang Yuan-Sheng, Tsai Mu-Jung, Tsai Chieh-Jui, Wang Chih-Chi, Lin Chih-Che, Yen Yi-Hao, Hung Chao-Hung, Kuo Yuan-Hung, Huang Ding-Sen, Tai Wei-Chen, Hu Tsung-Hui, Tsai Ming-Chao
Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine Kaohsiung, Taiwan.
School of Medicine, Kaohsiung Medical University Hospital Kaohsiung, Taiwan.
Am J Cancer Res. 2024 Oct 15;14(10):4979-4988. doi: 10.62347/ZGRJ7827. eCollection 2024.
Microscopic vascular invasion (MVI) has been demonstrated as a strong risk factor associated with tumor recurrence and poor overall survival among hepatocellular carcinoma (HCC) patients after resection, but the preoperative prediction of MVI is still challenging. We aimed to build and validate a novel model to predict MVI in the preoperative setting. We retrospectively collected 857 patients with Barcelona Clinic Liver Cancer (BCLC) stage 0 or A HCC who underwent primary resection at Kaohsiung Chang Gung Hospital between January 2001 and June 2016. The patients were randomized into derivation (n = 648) and validation groups (n = 209). Logistic regression analysis was used to screen out independent risk factors for MVI and further constructed a predictive model for MVI. Prediction performance was compared by the area under the receiver operating characteristic curve (AUC). The multivariable logistic regression analysis of the training cohort found that alpha-fetoprotein (AFP) ≥ 20 ng/mL (OR = 1.96, 95% CI: 1.41-2.73, P < 0.001), albumin < 3.5 g/dL (OR = 1.48, 95% CI: 1.06-2.05, P = 0.019) and tumor burden score (TBS) ≥ 8.6 (OR = 2.54, 95% CI: 1.49-4.35, P = 0.001) to be independent risk factors for MVI. The three factors were chosen to build a model for prediction of MVI. The AUC for the training and validation group was 0.619 (95% CI: 0.575-0.663) and 0.642 (95% CI: 0.562-0.722), respectively, and the calibration plot showed good performance of the prediction model, with a low mean absolute error at 0.01. In conclusion, the new model comprised AFP, albumin, and TBS that can predict risk of MVI for early-stage HCC.
微血管侵犯（MVI）已被证明是肝细胞癌（HCC）患者切除术后肿瘤复发和总体生存率差的一个重要危险因素，但术前对MVI的预测仍然具有挑战性。我们旨在建立并验证一种新的模型，用于在术前预测MVI。我们回顾性收集了2001年1月至2016年6月在高雄长庚医院接受初次切除的857例巴塞罗那临床肝癌（BCLC）0期或A期HCC患者。这些患者被随机分为推导组（n = 648）和验证组（n = 209）。采用逻辑回归分析筛选出MVI的独立危险因素，并进一步构建MVI预测模型。通过受试者操作特征曲线（AUC）下面积比较预测性能。训练队列的多变量逻辑回归分析发现，甲胎蛋白（AFP）≥20 ng/mL（OR = 1.96，95%CI：1.41 - 2.73，P < 0.001）、白蛋白<3.5 g/dL（OR = 1.48，95%CI：1.06 - 2.05，P = 0.019）和肿瘤负荷评分（TBS）≥8.6（OR = 2.54，95%CI：1.49 - 4.35，P = 0.001）是MVI的独立危险因素。选择这三个因素构建MVI预测模型。训练组和验证组的AUC分别为0.619（95%CI：0.575 - 0.663）和0.642（95%CI：0.562 - 0.722），校准图显示预测模型性能良好，平均绝对误差低至0.01。总之，新模型包含AFP、白蛋白和TBS，可预测早期HCC的MVI风险。
