Nomogram to Assist in Surgical Plan for Hepatocellular Carcinoma: a Prediction Model for Microvascular Invasion

Lin, Shengtao; Ye, Feng; Rong, Weiqi; Song, Ying; Wu, Fan; Liu, Yunhe; Zheng, Yiling; Siqin, Tana; Zhang, Kai; Wang, Liming; Wu, Jianxiong

doi:10.1007/s11605-019-04140-0

Cited by 37 publications

(37 citation statements)

References 40 publications

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“…Previously, a few studies reported that a higher serum level of AFP was one of the independent risk factors associated with MVI in HCC [32,33] and ICC [34] patients. Our findings also showed that a higher serum level of AFP was an independent predictor of MVI in cHCC-CCA, but when the serum level of AFP was between 20 and 400 ng/ml, there were no significant differences in MVI.…”

Section: Discussionmentioning

confidence: 99%

Combined hepatocellular-cholangiocarcinoma: which preoperative clinical data and conventional MRI characteristics have value for the prediction of microvascular invasion and clinical significance?

Wang

et al. 2020

Eur Radiol

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Objectives To explore which preoperative clinical data and conventional MRI findings may indicate microvascular invasion (MVI) of combined hepatocellular-cholangiocarcinoma (cHCC-CCA) and have clinical significance. Methods The study enrolled 113 patients with histopathologically confirmed cHCC-CCA (MVI-positive group [n = 56], MVI-negative group [n = 57]). Two radiologists retrospectively assessed the preoperative MRI features (qualitative analysis of morphology and dynamic enhancement features), and each lesion was assigned according to the LI-RADS. Preoperative clinical data were also evaluated. Logistic regression analyses were used to assess the relative value of these parameters as potential predictors of MVI. Recurrence-free survival (RFS) rates after hepatectomy in the two groups were estimated using Kaplan–Meier survival curves and compared using the log-rank test. Results The majority of cHCC-CCAs were categorized as LR-M. On multivariate analysis, a higher serum AFP level (OR, 0.523; 95% CI, 0.282–0.971; p = 0.040), intratumoral fat deposition (OR, 14.368; 95% CI, 2.749–75.098; p = 0.002), and irregular arterial peritumoral enhancement (OR, 0.322; 95% CI, 0.164–0.631; p = 0.001) were independent variables associated with the MVI of cHCC-CCA. After hepatectomy, patients with MVI of cHCC-CCA showed earlier recurrence than those without MVI (hazard ratio [HR], 0.402; 95% CI, 0.189–0.854, p = 0.013). Conclusion A higher serum AFP level and irregular arterial peritumoral enhancement are potential predictive biomarkers for the MVI of cHCC-CCA, while intratumoral fat detected on MRI suggests a low risk of MVI. Furthermore, cHCC-CCAs with MVI may have worse surgical outcomes with regard to early recurrence than those without MVI. Key Points • Higher serum levels of AFP combined with irregular arterial peritumoral enhancement are independent risk factors for the MVI of cHCC-CCA, while fat deposition might be a protective factor. • cHCC-CCA with MVI may have a higher risk of early recurrence after surgery. • Most cHCC-CCAs were categorized as LR-M in this study, and no significant difference was found in MVI based on LI-RADS category.

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Section: Discussionmentioning

confidence: 99%

Combined hepatocellular-cholangiocarcinoma: which preoperative clinical data and conventional MRI characteristics have value for the prediction of microvascular invasion and clinical significance?

Wang

et al. 2020

Eur Radiol

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“…Many studies focusing on MVI status prediction in HCC demonstrate that image features (e.g., tumor size, peritumoral enhancement, non-smooth tumor margin, peritumoral hypo-intensity at the hepatobiliary phase, intra-tumoral artery, and non-nodule type) are correlated with MVI status in HCC, which can be utilized to predict MVI status in HCC ( 10 – 12 , 30 , 36 , 38 , 40 , 44 – 47 ). Among them, peritumor enhancement and non-smooth tumor margin are considered as important independent predictors in different studies ( 11 , 44 – 46 ). However, mosaic architecture is the only independent predictor of MVI in Liver Imaging Reporting and Data System category 5 (LR-5) HCCs based on LI-RADS ( 44 ).…”

Section: Discussionmentioning

confidence: 99%

“…The selection procedure is shown in Figure 1 (23). In total, 33 studies involving nine studies based on radiomics (17)(18)(19)(24)(25)(26)(27)(28)(29)) and 24 studies based on non-radiomics (10)(11)(12)(13)(14)(15)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47) were eligible for this diagnostic meta-analysis. A total of 5,462 HCC patients were included.…”

Section: Literature Selection and Quality Assessmentmentioning

confidence: 99%

Preoperative Prediction Power of Imaging Methods for Microvascular Invasion in Hepatocellular Carcinoma: A Systemic Review and Meta-Analysis

et al. 2020

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Background: To compare the predictive power between radiomics and non-radiomics (conventional imaging and functional imaging methods) for preoperative evaluation of microvascular invasion (MVI) in hepatocellular carcinoma (HCC). Methods: Comprehensive publications were screened in PubMed, Embase, and Cochrane Library. Studies focusing on the discrimination values of imaging methods, including radiomics and non-radiomics methods, for MVI evaluation were included in our meta-analysis. Results: Thirty-three imaging studies with 5,462 cases, focusing on preoperative evaluation of MVI status in HCC, were included. The sensitivity and specificity of MVI prediction in HCC were 0.78 [95% confidence interval (CI): 0.75-0.80; I 2 = 70.7%] and 0.78 (95% CI: 0.76-0.81; I 2 = 0.0%) for radiomics, respectively, and were 0.73 (95% CI: 0.71-0.75; I 2 = 83.7%) and 0.82 (95% CI: 0.80-0.83; I 2 = 86.5%) for non-radiomics, respectively. The areas under the receiver operation curves for radiomics and non-radiomics to predict MVI status in HCC were 0.8550 and 0.8601, respectively, showing no significant difference. Conclusion: The imaging method is feasible to predict the MVI state of HCC. Radiomics method based on medical image data is a promising application in clinical practice and can provide quantifiable image features. With the help of these features, highly consistent prediction performance will be achieved in anticipation.

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“…Previous studies ( 6 , 7 ) used tumor boundary as well as diameter to predict MVI, but further clinical validation was required. In addition, we represented the first study to report the discomfort of the right upper abdomen for preoperative prediction of MVI.…”

Section: Discussionmentioning

confidence: 99%

“…Lots of efforts have been taken to explore the relationships between preoperative parameters and MVI. Tumor diameter has been reported to be predictors for MVI in HCC patients ( 6 , 7 ). However, the cut-off values of tumor diameter are inconsistent and they are just simply divided by equidistance.…”

Section: Introductionmentioning

confidence: 99%

A Nomogram for Preoperative Estimation of Microvascular Invasion Risk in Hepatocellular Carcinoma: Single-Center Analyses With Internal Validation

et al. 2021

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BackgroundMicrovascular invasion (MVI) is highly associated with poor prognosis in patients with liver cancer. Predicting MVI before surgery is helpful for surgeons to better make surgical plan. In this study, we aim at establishing a nomogram to preoperatively predict the occurrence of microvascular invasion in liver cancer.MethodA total of 405 patients with postoperative pathological reports who underwent curative hepatocellular carcinoma resection in the Third Affiliated Hospital of Sun Yat-sen University from 2013 to 2015 were collected in this study. Among these patients, 290 were randomly assigned to the development group while others were assigned to the validation group. The MVI predictive factors were selected by Lasso regression analysis. Nomogram was established to preoperatively predict the MVI risk in HCC based on these predictive factors. The discrimination, calibration, and effectiveness of nomogram were evaluated by internal validation.ResultsLasso regression analysis revealed that discomfort of right upper abdomen, vascular invasion, lymph node metastases, unclear tumor boundary, tumor necrosis, tumor size, higher alkaline phosphatase were predictive MVI factors in HCC. The nomogram was established with the value of AUROC 0.757 (0.716–0.809) and 0.768 (0.703–0.814) in the development and the validation groups. Well-fitted calibration was in both development and validation groups. Decision curve analysis confirmed that the predictive model provided more benefit than treat all or none patients. The predictive model demonstrated sensitivity of 58.7%, specificity of 80.7% at the cut-off value of 0.312.ConclusionNomogram was established for predicting preoperative risk of MVI in HCC. Better treatment plans can be formulated according to the predicted results.

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Nomogram to Assist in Surgical Plan for Hepatocellular Carcinoma: a Prediction Model for Microvascular Invasion

Cited by 37 publications

References 40 publications

Combined hepatocellular-cholangiocarcinoma: which preoperative clinical data and conventional MRI characteristics have value for the prediction of microvascular invasion and clinical significance?

Combined hepatocellular-cholangiocarcinoma: which preoperative clinical data and conventional MRI characteristics have value for the prediction of microvascular invasion and clinical significance?

Preoperative Prediction Power of Imaging Methods for Microvascular Invasion in Hepatocellular Carcinoma: A Systemic Review and Meta-Analysis

A Nomogram for Preoperative Estimation of Microvascular Invasion Risk in Hepatocellular Carcinoma: Single-Center Analyses With Internal Validation

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