Novel Nomogram Based on Inflammatory Markers for the Preoperative Prediction of Microvascular Invasion in Solitary Primary Hepatocellular Carcinoma

Abstract

Purpose We aimed to develop and to validate a novel nomogram based on inflammatory markers to preoperatively predict microvascular invasion (MVI) in patients with solitary primary hepatocellular carcinoma (HCC). Patients and Methods Data from 658 patients with solitary primary HCC who underwent hepatectomy at the First Affiliated Hospital of Zhengzhou University from June 2018 to October 2021 were retrospectively analyzed. Patients were divided into training (n=441) and validation (n=217) cohorts according to surgical data. Independent risk factors for MVI were identified via univariate and multivariate logistic regression analyses in the training cohort. A novel nomogram was developed based on the independent risk factors identified. Its accuracy was evaluated using a calibration curve and concordance index (C-index). The predictive value was evaluated using the receiver operating characteristic (ROC) curve and decision curve analysis (DCA). Results Preoperative alpha-fetoprotein >969 µg/L (P<0.001), tumor size (P=0.002), neutrophil >1.8×10 9 /L (P=0.002), gamma-glutamyl transpeptidase-to-platelet ratio (GPR) >0.32 (P=0.001), aspartate aminotransferase-to-platelet ratio (APR) >0.18 (P<0.001), gamma-glutamyl transpeptidase-to-albumin ratio (GAR) >2.30 (P=0.001), and gamma-glutamyl transpeptidase-to-lymphocyte ratio >29.58 (P<0.001) were identified as preoperative independent risk factors for MVI and were used to establish the nomogram. The C-index of the training and validation cohorts were 0.788 (95% confidence interval [CI]: 0.744–0.831) and 0.735 (95% CI: 0.668–0.802), respectively. The calibration curve analysis revealed that the standard curve fit well with the predicted curve. ROC curve analysis demonstrated high efficiency of the nomogram. DCA verified that the nomogram had notable clinical value. Conclusion Preoperative GPR >0.32, APR >0.18, and GAR >2.30 were independent risk factors for MVI in patients with solitary primary HCC, suggesting their utility as preoperative predictors of MVI. The novel nomogram developed and validated in this study may aid in determining optimal therapeutic approaches for patients with solitary HCC at risk for MVI.

Platelet count as a predictor of vascular invasion and extrahepatic metastasis in hepatocellular carcinoma: A systematic review and meta-analysis

“…The recruited population were from China in ten publications, from Japan in two publications, from Austria in one publication, and from America in one publication. HCC patients received hepatectomy in six studies [ [21] , [22] , [23] , [30] , [31] , [32] ], interventional therapies in three studies [ 24 , 29 , 34 ], and mixed therapies in other studies. The cut-off of PLT ranged from 100ⅹ10 9 /L to 222ⅹ10 9 /L.…”

“…Eleven studies with a total of 8759 HCC patients reported the effect of PLT on VI. According to the types of VI, MVI were recorded in seven studies [ 22 , 23 , 27 , 28 , [30] , [31] , [32] ], PVTT in two studies [ 26 , 29 ], and any VI in two studies [ 21 , 25 ]. Meta-analysis demonstrated that, there was a significantly elevated risk of VI in patients with a high level of PLT (11 studies, 8759 patients; OR = 1.44, 95%CI: 1.02–2.02) ( Fig.…”

Multiple Machine-Learning Fusion Model Based on Gd-EOB-DTPA-Enhanced MRI and Aminotransferase-to-Platelet Ratio and Gamma-Glutamyl Transferase-to-Platelet Ratio to Predict Microvascular Invasion in Solitary Hepatocellular Carcinoma: A Multicenter Study

“…Similarly, the AUC of another nomogram was 0.839 (n = 627 HCCs, single center), lacking calibration, validation data and external validation. 19 Furthermore, Gu et al 20 developed a model for predicting MVI based on seven features without external validation (n = 658 HCCs, single center), and the AUCs in training and validation set were 0.788 and 0.735, respectively. Meanwhile, Tang et al 45 also developed a nomogram (n = 273 patients, single center), with an AUC of 0.754 in training set and an AUC of 0.746 in validation set.…”

“…The conclusions drawn between different studies are also inconsistent, and the best cutoff values are also different. [18][19][20] In addition, some previous studies have suggested that aminotransferase-to-platelet ratio (APRI) [21][22][23] and gamma-glutamyl transferase-to-platelet ratio (GPR) [24][25][26] are independent risk factors for shorter survival and higher recurrence after HCC surgery. However, it is still uncertain whether preoperative APRI or GPR can predict MVI in solitary HCC, and there is no report on the relationship between APRI/GPR and MVI.…”

Establishment and verification of a prognostic model of liver cancer by RNA-binding proteins based on the TCGA database

“…The collected pathological results show that the tissue structures of the normal tissue and tumor tissue are different, as shown in Figure 10. relationship between specific molecular markers of liver cancer and its treatment and prognosis (25)(26)(27). However, there is no relevant previous research on an RBP prognostic model of liver cancer.…”