Abstract
BackgroundMounting studies reveal the relationship between inflammatory markers and post-therapy prognosis. Yet, the role of the systemic inflammatory indices in preoperative microvascular invasion (MVI) prediction for hepatocellular carcinoma (HCC) remains unclear.Patients and MethodsIn this study, data of 1,058 cases of patients with HCC treated in the First Affiliated Hospital of Sun Yat-sen University from February 2002 to May 2018 were collected. Inflammatory factors related to MVI diagnosis in patients with HCC were selected by least absolute shrinkage and selection operator (LASSO) regression analysis and were integrated into an “Inflammatory Score.” A prognostic nomogram model was established by combining the inflammatory score and other independent factors determined by multivariate logistic regression analysis. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) were used to evaluate the predictive efficacy of the model.ResultsSixteen inflammatory factors, including neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, etc., were selected by LASSO regression analysis to establish an inflammatory score. Multivariate logistic regression analysis showed that inflammatory score (OR = 2.14, 95% CI: 1.63–2.88, p < 0.001), alpha fetoprotein (OR = 2.02, 95% CI: 1.46–2.82, p < 0.001), and tumor size (OR = 2.37, 95% CI: 1.70–3.30, p < 0.001) were independent factors for MVI. These three factors were then used to establish a nomogram for MVI prediction. The AUC for the training and validation group was 0.72 (95% CI: 0.68–0.76) and 0.72 (95% CI: 0.66–0.78), respectively.ConclusionThese findings indicated that the model drawn in this study has a high predictive value which is capable to assist the diagnosis of MVI in patients with HCC.
Highlights
Hepatocellular carcinoma (HCC) is the sixth most common cancer and the third leading cause of cancer-related deaths worldwide, with a recurrence rate up to 70% at 5 years after resection and 15–40% after liver transplantation [1–5].Microvascular invasion (MVI) is defined as a cluster of tumor cells in the vessels of the surrounding hepatic tissue lined by endothelium, which was visible only under the microscopy [6]
There was no significant difference between the training group and validation group in regard to the distribution of characteristics (p = 0.10–0.89), with the exception of PLT (p < 0.001), platelet-to-lymphocyte ratio (PLR) (p = 0.006), aspartate transaminase-to-platelet ratio index (APRI) (p = 0.01), and FIB-4 (p = 0.02)
A nomogram was developed based on inflammatory score, alpha fetoprotein (AFP), and tumor size for patients with hepatocellular carcinoma (HCC) to identify MVI before surgery
Summary
Hepatocellular carcinoma (HCC) is the sixth most common cancer and the third leading cause of cancer-related deaths worldwide, with a recurrence rate up to 70% at 5 years after resection and 15–40% after liver transplantation [1–5].Microvascular invasion (MVI) is defined as a cluster of tumor cells in the vessels of the surrounding hepatic tissue lined by endothelium, which was visible only under the microscopy [6]. Hepatocellular carcinoma (HCC) is the sixth most common cancer and the third leading cause of cancer-related deaths worldwide, with a recurrence rate up to 70% at 5 years after resection and 15–40% after liver transplantation [1–5]. The incidence of MVI in HCC is highly variable between studies (ranged from 15 to 57.1%) [7]. It has been widely accepted that the presence of MVI is a symbol of aggressive biological behavior and is a critical factor related to high recurrence rate and long term overall survival in patients who undergo resection or liver transplant [7–10]. It is important to be able to predict MVI for patients with HCC before surgery. The role of the systemic inflammatory indices in preoperative microvascular invasion (MVI) prediction for hepatocellular carcinoma (HCC) remains unclear
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