Abstract
BackgroundMicrovascular invasion (MVI) is a significant predictive factor for early recurrence, metastasis, and poor prognosis of hepatocellular carcinoma. The aim of the present study is to identify preoperative factors for predicting MVI, in addition to develop and validate non-invasive nomogram for predicting MVI.MethodsA total of 381 patients with resected HCC were enrolled and divided into a training cohort (n = 267) and a validation cohort (n = 114). Serum VEGF-A level was examined by enzyme-linked immunosorbent assay (ELISA). Risk factors for MVI were assessed based on univariate and multivariate analyses in the training cohort. A nomogram incorporating independent risk predictors was established and validated.ResultThe serum VEGF-A levels in the MVI positive group (n = 198) and MVI negative group (n = 183) were 215.25 ± 105.68 pg/ml and 86.52 ± 62.45 pg/ml, respectively (P <0.05). Serum VEGF-A concentration ≥138.30 pg/ml was an independent risk factor of MVI (OR: 33.088; 95%CI: 12.871–85.057; P <0.001). Higher serum concentrations of AFP and VEGF-A, lower lymphocyte count, peritumoral enhancement, irregular tumor shape, and intratumoral artery were identified as significant predictors for MVI. The nomogram indicated excellent predictive performance with an AUROC of 0.948 (95% CI: 0.923–0.973) and 0.881 (95% CI: 0.820–0.942) in the training and validation cohorts, respectively. The nomogram showed a good model fit and calibration.ConclusionsHigher serum concentrations of AFP and VEGF-A, lower lymphocyte count, peritumoral enhancement, irregular tumor shape, and intratumoral artery are promising markers for MVI prediction in HCC. A reliable non-invasive nomogram which incorporated blood biomarkers and imaging risk factors was established and validated. The nomogram achieved desirable effectiveness in preoperatively predicting MVI in HCC patients.
Highlights
Hepatocellular carcinoma(HCC)is the sixth most commonly diagnosed cancer and the fourth leading cause for cancerrelated deaths worldwide [1]
Given that Microvascular invasion (MVI) status may influence the choice of treatment, it is necessary to develop an accurate predictive model of MVI based on available factors
A total of 685 HCC patients underwent a radical (R0) partial hepatectomy in our center, and 381 qualified patients were enrolled in the final study (Figure 1)
Summary
Hepatocellular carcinoma(HCC)is the sixth most commonly diagnosed cancer and the fourth leading cause for cancerrelated deaths worldwide [1]. Surgical resection and liver transplantation are the potentially curative treatments for HCC patients at early stage [2, 3]. The poor prognosis of HCC patients is largely due to the high frequency of tumor recurrence and metastasis after surgical treatments [4, 5]. Microvascular invasion is an independent risk factor for early recurrence, metastasis, and poor prognosis of HCC [6, 7]. For HCC patient identified with MVI positive, tumors should be surgically resected with wide margins [10]. Microvascular invasion (MVI) is a significant predictive factor for early recurrence, metastasis, and poor prognosis of hepatocellular carcinoma. The aim of the present study is to identify preoperative factors for predicting MVI, in addition to develop and validate non-invasive nomogram for predicting MVI
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