Establishment, validation and evaluation of predictive model for early relapse after R0 resection in hepatocellular carcinoma patients with microvascular invasion

Kai Zhang,Tana Siqin,Changcheng Tao,Jianxiong Wu,Weiqi Rong

doi:10.1186/s12967-021-02940-0

Abstract

BackgroundsThis is the first study to build and evaluate a predictive model for early relapse after R0 resection in hepatocellular carcinoma (HCC) patients with microvascular invasion (MVI).MethodsThe consecutive HCC patients with MVI who underwent hepatectomy in Cancer Hospital of Chinese Academy of Medical Science from Jan 2014 to June 2019 were retrospectively enrolled and randomly allocated into a derivation (N = 286) and validation cohort (N = 120) in a ratio of 7:3. Cox regression and Logistic regression analyses were performed and a predictive model for postoperative early-relapse were developed.ResultsA total of 406 HCC patients with MVI were included in our work. Preoperative blood alpha-fetoprotein (AFP) level, hepatitis B e antigen (HBeAg) status, MVI classification, largest tumor diameter, the status of serosal invasion, number of tumors, and the status of satellite nodules were incorporated to construct a model. The concordance index (C-index) was 0.737 and 0.736 in the derivation and validation cohort, respectively. The calibration curves showed a good agreement between actual observation and nomogram prediction. The C-index of the nomogram was obviously higher than those of the two traditional HCC staging systems.ConclusionWe have developed and validated a prediction model for postoperative early-relapse in HCC patient with MVI after R0 resection.

Highlights

Hepatocellular carcinoma (HCC) is the sixth and fourth most common malignant tumor worldwide and in China, respectively
Some studies have revealed that the relapse-free survival (RFS) and overall survival (OS) in patients with a HCC diameter < 2 cm after receiving ablation therapy are shorter than those receiving surgical resection [9]
Inclusion criteria: (1) HCC with microvascular invasion (MVI) confirmed by the postoperative pathological examination; (2) R0 resection confirmed by the postoperative pathological examination; (3) Child–Pugh A liver function prior to surgery; (4) No serious dysfunction of heart, lung or kidney that impacts on prognosis; (5) Eastern Cooperative Oncology Group (ECOG) performance status of 0–1

Summary

Introduction

Hepatocellular carcinoma (HCC) is the sixth and fourth most common malignant tumor worldwide and in China, respectively It is the fourth and third most common cause of cancer-related death worldwide and in China, respectively [1]. It is well known that liver transplantation, radiotherapy, ablation, and hepatectomy are the main local treatment strategies for primary HCC patients. The treatment efficacy of ablation therapy is commonly comparable with that of surgical resection in HCC patients [8]. HCC patients with MVI who receive ablation therapy exhibits a higher early-recurrence rate than those receive surgical resection [10]. Surgical resection is still the main treatment strategy for radical intent in HCC patients

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Results

Discussion

Conclusion