Abstract
Purpose: To establish a valid prediction model to prognose the occurrence of microvascular invasion (MVI), and to compare the efficacy of anatomic resection (AR) or non-anatomic resection (NAR) for hepatocellular carcinoma (HCC).Methods: Two hundred twenty-eight patients with HCC who underwent surgical treatment were enrolled. Their hematological indicators, MRI imaging features, and outcome data were acquired.Result: In the multivariable analysis, alpha-fetoprotein >15 ng/mL, neutrophil to lymphocyte ratio >3.8, corona enhancement, and peritumoral hypointensity on hepatobiliary phase were associated with MVI. According on these factors, the AUROC of the predictive model in the primary and validation cohorts was 0.884 (95% CI: 0.829, 0.938) and 0.899 (95% CI: 0.821, 0.967), respectively. Patients with high risk of MVI or those with low risk of MVI but tumor size >5 cm in the AR group were associated with a lower rate of recurrence and death than patients in the NAR group; however, when patients are in the state of low-risk MVI with tumor size >5 cm, there is no difference in the rate of recurrence and death between AR and NAR.Conclusion: Our predictive model for HCC with MVI is convenient and accurate. Patients with high-risk of MVI or low-risk of MVI but tumor size >5 cm executing AR is of great necessity.
Highlights
Vascular invasion of hepatocellular carcinoma (HCC) include macrovascular invasion and microvascular invasion in pathology, both of which are predictors of poor prognosis after surgical resection or liver transplantation [1, 2]
To establish a valid prediction model to prognose the occurrence of microvascular invasion (MVI), and to compare the efficacy of anatomic resection (AR) or non-anatomic resection (NAR) for hepatocellular carcinoma (HCC)
Patients with high-risk of MVI or low-risk of MVI but tumor size >5 cm executing anatomical resection (AR) is of great necessity
Summary
Vascular invasion of hepatocellular carcinoma (HCC) include macrovascular invasion and microvascular invasion in pathology, both of which are predictors of poor prognosis after surgical resection or liver transplantation [1, 2]. The 5-year recurrence rate of HCC patients with microvascular invasion after radical hepatic resection is reportedly as high as 70%, and tumor recurrence rate exceeds 35% even after liver transplantation [3, 4]. Despite the potential of Radiomics to guide clinical decision making, there is a lack of standardized evaluation toward numerous published Radiomics studies; Radiomics necessitates interdisciplinary cooperation. These two factors are the reason why Radiomics is difficult to be implemented in many hospitals. A simple and effective method capable of predicting the incidence of MVI prior to surgery is urgently needed to improve prognosis after radical resection in patients with HCC
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