Journal Article

A Novel Online Calculator to Predict Risk of Microvascular Invasion in the Preoperative Setting for Hepatocellular Carcinoma Patients Undergoing Curative-Intent Surgery

Endo, Yutaka, Lam, Vincent, Guglielmi, Alfredo, Aldrighetti, Luca, Pawlik, Timothy M, Marques, Hugo P, Workneh, Aklile, Popescu, Irinel, Endo, Itaru, Alaimo, Laura, Ratti, Francesca, Soubrane, Olivier, Hugh, Tom, Poultsides, George A, Moazzam, Zorays, Lima, Henrique A, Kitago, Minoru, Alexandrescu, Sorin, Martel, Guillaume

2023

Overview

BackgroundThe presence of microvascular invasion (MVI) has been highlighted as an important determinant of hepatocellular carcinoma (HCC) prognosis. We sought to build and validate a novel model to predict MVI in the preoperative setting.MethodsPatients who underwent curative-intent surgery for HCC between 2000 and 2020 were identified using a multi-institutional database. Preoperative predictive models for MVI were built, validated, and used to develop a web-based calculator.ResultsAmong 689 patients, MVI was observed in 323 patients (46.9%). On multivariate analysis in the test cohort, preoperative parameters associated with MVI included α-fetoprotein (AFP; odds ratio [OR] 1.50, 95% confidence interval [CI] 1.23–1.83), imaging tumor burden score (TBS; hazard ratio [HR] 1.11, 95% CI 1.04–1.18), and neutrophil-to-lymphocyte ratio (NLR; OR 1.18, 95% CI 1.03–1.35). An online calculator to predict MVI was developed based on the weighted β-coefficients of these three variables (https://yutaka-endo.shinyapps.io/MVIrisk/). The c-index of the test and validation cohorts was 0.71 and 0.72, respectively. Patients with a high risk of MVI had worse disease-free survival (DFS) and overall survival (OS) compared with low-risk MVI patients (3-year DFS: 33.0% vs. 51.9%, p < 0.001; 5-year OS: 44.2% vs. 64.8%, p < 0.001). DFS was worse among patients who underwent an R1 versus R0 resection among those patients at high risk of MVI (R0 vs. R1 resection: 3-year DFS, 36.3% vs. 16.1%, p = 0.002). In contrast, DFS was comparable among patients at low risk of MVI regardless of margin status (R0 vs. R1 resection: 3-year DFS, 52.9% vs. 47.3%, p = 0.16).ConclusionPreoperative assessment of MVI using the online tool demonstrated very good accuracy to predict MVI.

• Publisher: Springer Nature B.V
• Subject: Hepatocellular carcinoma / Leukocytes (neutrophilic) / Liver cancer / Lymphocytes / Medical prognosis / Microvasculature / Multivariate analysis / Prediction models / Surgery / Tumors / α-Fetoprotein