Establishment of a clinical model based on vessels encapsulating tumour clusters that could efficiently predict recurrence of patients with hepatocellular carcinoma after curative hepatectomy

Abstract

According to previous studies, vessels encapsulating tumor clusters (VETC) could promote metastasis of hepatocellular carcinoma (HCC) in a manner independent from epithelial-mesenchymal transition (EMT). However, the prognostic significance of VETC among patients undergoing curative hepatectomy has not been fully explored. This study was performed to assess the prognostic significance of VETC among patients undergoing curative hepatectomy.81 patients undergoing curative hepatectomy were included in this study. A predictive model based on VETC was established. Then this predictive model based on VETC was compared with American Joint Committee on Cancer Tumor Nodal Metastasis (AJCC TNM) and Barcelona Clinic Liver Cancer (BCLC) system.It was revealed by multivariate Cox regression analysis that high neutrophil lymphocyte ratio (NLR) (P=0.013, HR=6.175, 95%CI: 1.468-25.977), number of tumors (P＜0.001, HR=4.119, 95%CI 1.886-8.995) and VETC positivity (P=0.010, HR=2.440, 95%CI 1.235-4.821) were independent predictive factors for disease-free survival (DFS). Additionally, by Kaplan-Meier analysis, we revealed that VETC positivity was associated with worse DFS (P=0.018). Then the clinical predictive model combining NLR, number of tumors, and VETC was compared with AJCC TNM stage and BCLC classification system by performing time-dependent receiver operating curve (td-ROC) analysis, revealing that the clinical predictive model was superior to AJCC TNM stage and BCLC system at different time points. Additionally, we demonstrated that the clinical model could well predict DFS by plotting calibration curves.VETC could be utilized as an efficient prognostic factor for HCC and the clinical predictive model combining NLR, number of tumors, and VETC was superior to AJCC TNM stage and BCLC system in predicting cancer recurrence.