Lai Quirino, Pawlik Timothy M, Ajdini Suela, Emond Jean, Halazun Karim, Soin Arvinder S, Bhangui Prashant, Yoshizumi Tomoharu, Toshima Takeo, Panzer Marlene, Schaefer Benedikt, Hoppe-Lotichius Maria, Mittler Jens, Ito Takashi, Hatano Etsuro, Rossi Massimo, Chan Albert C Y, Wong Tiffany, Chen Chao-Long, Lin Chih-Che, Vitale Alessandro, Coubeau Laurent, Cillo Umberto, Lerut Jan P
General Surgery and Organ Transplantation Unit, AOU Policlinico Umberto I, Sapienza University of Rome, 00185 Rome, Italy.
Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.
Cancers (Basel). 2025 Apr 24;17(9):1418. doi: 10.3390/cancers17091418.
MVI is a relevant prognostic factor among patients with hepatocellular carcinoma (HCC) receiving liver transplantation (LT). The preoperative assessment of the risk for MVI is relevant to pre-LT patient management and selection. The objective of this study was to create and validate a model to predict microvascular invasion (MVI) based on preoperative variables in the LT setting. : A total of 2170 patients from 11 collaborative centers in Europe, Asia, and the US, who received transplants between 1 January 2000 and 31 December 2017, were enrolled in the study. The entire cohort was split into a training and a validation set (70/30% of the initial cohort, respectively) using random selection. : MVI was reported in 586 (27.0%) explanted specimens. Using the training set data, multivariable logistic regression identified three preoperative parameters associated with MVI: α-fetoprotein (lnAFP; odds ratio [OR] = 1.19; 95% confidence interval [CI] = 1.13-1.27), imaging tumor burden score (lnTBS; OR = 1.66; 95%CI = 1.39-1.99), and a fast-track approach before LT due to the availability of a live donation (OR = 1.99; 95%CI = 1.56-2.53). In the validation set, the LT-MVI c-index was 0.74, versus 0.69 for the MVI score proposed by Endo et al. (Brier Skill Score +75%). The new score had a relevant net reclassification index (overall value = 0.61). Stratifying the validation set into three risk categories (0-50th, 51st-75th, and >75th score percentiles), a very good stratification was observed in terms of disease-free (5-year: 89.3, 75.5, and 50.7%, respectively) and overall survival (5-year: 79.5, 72.6, and 53.7%, respectively). : The preoperative assessment of MVI using the proposed score demonstrated very good accuracy in predicting MVI after LT.
微血管侵犯（MVI）是接受肝移植（LT）的肝细胞癌（HCC）患者的一个相关预后因素。术前评估MVI风险与LT前患者管理及选择相关。本研究的目的是建立并验证一个基于LT术前变量预测微血管侵犯（MVI）的模型。：来自欧洲、亚洲和美国11个协作中心的2170例患者纳入研究，这些患者在2000年1月1日至2017年12月31日期间接受了移植。使用随机选择将整个队列分为训练集和验证集（分别占初始队列的70%/30%）。：586例（27.0%）切除标本报告有MVI。利用训练集数据，多变量逻辑回归确定了与MVI相关的三个术前参数：甲胎蛋白（lnAFP；比值比[OR]=1.19；95%置信区间[CI]=1.13 - 1.27）、影像肿瘤负荷评分（lnTBS；OR = 1.66；95%CI = 1.39 - 1.99）以及因有活体供肝而在LT前采用的快速通道方法（OR = 1.99；95%CI = 1.56 - 2.53）。在验证集中，LT - MVI的c指数为0.74，而Endo等人提出的MVI评分的c指数为0.69（Brier技能评分提高75%）。新评分具有相关的净重新分类指数（总体值 = 0.61）。将验证集分为三个风险类别（第0 - 50百分位、第51 - 75百分位和>第75百分位评分），在无病生存（5年：分别为89.3%、75.5%和50.7%）和总生存（5年：分别为79.5%、72.6%和53.7%）方面观察到了非常好的分层。：使用所提出的评分对MVI进行术前评估在预测LT后MVI方面显示出非常好的准确性。
