Integrated Nomograms for Preoperative Prediction of Microvascular Invasion and Lymph Node Metastasis Risk in Hepatocellular Carcinoma Patients

Rethinking Resection and Transplant Candidacy for HCC: Should Tumor Biology Replace Size-Based Criteria?

“…For instance, thrombocytopenia has been included in other predictive scores as a measure of MVI related to splenic platelet sequestration secondary to sinusoidal congestion that defines MVI and is a sequelae of cirrhosis. 1,15 However, the present study suggests platelets [ 150 are associated with an increased risk of MVI as denoted by its positively weighted blood index coefficient. Additionally, CA-125 and CA 19-9 are included in the blood index.…”

“…Their MVI prediction nomogram includes increasing tumor diameter (\ 1 to [ 5 cm), increasing serum AFP (\ 20, 20-400, [ 400), HBV DNA [ 10 4 , platelets \ 100, typical dynamic on contrast-enhanced MRI (i.e., arterial phase hyper-attenuation and portal venous and delayed phase hypo-attenuation), multiple tumors, and incomplete encapsulation. 1 Their nomogram achieved a sensitivity of 73.5% and a specificity of 77%.…”

“…The current issue of Annals of Surgical Oncology includes a study by Yan and colleagues titled ''Integrated nomograms for the preoperative prediction of microvascular invasion and lymph node metastasis risk in hepatocellular carcinoma patients.'' 1 This study describes a nomogram, constructed from various preoperative variables, that predicts tumor microvascular invasion (MVI) with a sensitivity of 81.5% and specificity of 75.3% in training and validation patient cohorts (C-score of 0.828 and 0.804 respectively). Although this is not the first or largest nomogram-based study developed to predict MVI from preoperative factors, it has a comparatively high sensitivity and specificity and is part of a larger conversation regarding appropriate patient selection for liver resection and transplant in patients with hepatocellular carcinoma (HCC).…”

“…Although this is not the first or largest nomogram-based study developed to predict MVI from preoperative factors, it has a comparatively high sensitivity and specificity and is part of a larger conversation regarding appropriate patient selection for liver resection and transplant in patients with hepatocellular carcinoma (HCC). 1,2 The nomogram also includes a predictive nomogram for lymph node positivity, which has clinical value in risk-stratifying patients before major surgical intervention. However, the sensitivity and specificity of the nomogram for node positivity preclude it from being used as an active clinical tool and thus discussion of the clinical implications of their MVI prediction nomogram will be more instructive.…”

“…This contradiction is confusing, and is in contrast to other reports that indicate increasing tumor number as a risk factor for MVI. 1 Additionally, this information contradicts their nomogram scoring of BCLC stage where increasing BCLC stage has a higher risk of MVI; this is especially evident for BCLC Stage 0-B where tumor number plays a distinguishing role compared with other BCLC stage components (performance status and degree of cirrhosis). 20 The authors also relied on CT as their diagnostic and staging imaging modality.…”