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

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Microvascular invasion (MVI) relates to poor survival in hepatocellular carcinoma (HCC) patients. In this study, we aim at developing a nomogram for MVI prediction and potential assistance in surgical planning.

Methods

A total of 357 patients were assigned to training (n = 257) and validation (n = 100) cohort. Univariate and multivariate analyses were used to reveal preoperative predictors for MVI. A nomogram incorporating independent predictors was constructed and validated. Disease-free survival was compared between patients, and the potential of the predicted MVI in making surgical procedure was also explored.

Results

Pathological examination confirmed MVI in 140 (39.2%) patients. Imaging features including larger tumor, intra-tumoral artery, tumor type, and higher serum AFP independently correlated with MVI. The nomogram showed desirable performance with an AUROC of 0.803 (95% CI, 0.746–0.860) and 0.814 (95% CI, 0.720–0.908) in the training and validation cohorts, respectively. Good calibration were also revealed by calibration curve in both cohorts. The decision curve analysis indicated that the prediction nomogram was of promising usefulness in clinical work. In addition, survival analysis revealed that patients with positive-predicted MVI suffered a higher risk of early recurrence (P < 0.01). There was no difference in disease-free survival between anatomic or non-anatomic resection in large HCC or small HCC without nomogram-predicted MVI. However, anatomic resection improved disease-free survival in small HCC with nomogram-predicted MVI.

Conclusions

The nomogram obtained desirable results in predicting MVI. Patients with predicted MVI were associated with early recurrence and anatomic resection was recommended for small HCC patients with predicted MVI.

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Acknowledgements

We gratefully acknowledge Changfa Xia for the assistance in statistical analysis, Zhuo Li and Bo Zheng for reviewing the pathological results, and Kaijing Liu for revising the manuscript.

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Authors and Affiliations

  1. Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan NanLi, Chaoyang District, Beijing, China

    Shengtao Lin, Weiqi Rong, Fan Wu, Yunhe Liu, Yiling Zheng, Tana Siqin, Kai Zhang, Liming Wang & Jianxiong Wu

  2. Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Feng Ye & Ying Song

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  1. Shengtao Lin
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Contributions

Study concept and design: Liming Wang, Jianxiong Wu, Weiqi Rong

Clinical data acquisition: Shengtao Lin, Yunhe Liu, Yiling Zheng

Patient follow-up: Shengtao Lin, Yunhe Liu

Imaging feature evaluation: Feng Ye, Ying Song

Statistical analysis: Shengtao Lin, Fan Wu, Feng Ye, Tana Siqi

Drafting of the manuscript: Shengtao Lin, Yiling Zheng, Liming Wang

Study supervision: Liming Wang, Jianxiong Wu

Critical revision of the manuscript: all authors

Corresponding authors

Correspondence to Liming Wang or Jianxiong Wu.

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Figure S1

Flow chart of the study population. HCC: Hepatocellular Carcinoma, MR: Magnetic Resonance, TACE: Transhepatic Arterial Chemotherapy And Embolization, RFA: Radiofrequency Ablation. (PNG 491 kb)

High Resolution Image (TIF 2452 kb)

Figure S2

Disease-free survival between HCC patients. Kaplan-Meier survival curves and the Log-Rank Test compared the disease-free survival in patients with the actual presence or absence of MVI (A, P<0.01) and patients with the nomogram predicted presence or absence of MVI (B, P<0.01). (PNG 159 kb)

High Resolution Image (TIF 603 kb)

Figure S3

Disease-free survival in HCC patients received different surgical procedures. Kaplan-Meier survival curves and the Log-Rank Test compared the disease-free survival between different surgical procedures in the entire cohort (A, P=0.26), the patients with large HCCs (>5cm) (B, P=0.97), the patients with small HCCs (≤5cm) (C, P=0.09). (PNG 288 kb)

High Resolution Image (TIF 923 kb)

Table S1

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Lin, S., Ye, F., Rong, W. et al. Nomogram to Assist in Surgical Plan for Hepatocellular Carcinoma: a Prediction Model for Microvascular Invasion. J Gastrointest Surg 23, 2372–2382 (2019). https://doi.org/10.1007/s11605-019-04140-0

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