An excellent nomogram predicts microvascular invasion that cannot independently stratify outcomes of small hepatocellular carcinoma.
An excellent nomogram predicts microvascular invasion that cannot independently stratify outcomes of small hepatocellular carcinoma.
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出色的列线图可以预测微血管侵犯，但不能独立分层小肝细胞癌的结果。
DOI：
10.21037/atm-20-7952
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发表时间：
2021-05
影响因子：
--
通讯作者：
Zeng M
中科院分区：
文献类型：
--
作者：
Chong H;Zhou P;Yang C;Zeng M
微血管侵犯是否为小肝细胞癌（sHCC）的预后因素尚存在争议，临床需要基于gadoxetate二钠（Gd-EOB-DTPA） MRI的术前MVI预测模型。2012年3月至2020年9月，连续455例病理证实≤3cm的HCC患者行肝切除术并术前行Gd-EOB-DTPA MRI。采用单因素logistic回归和多因素logistic回归联合cox回归，找出队列中的混杂因素。采用倾向得分匹配（PSM）来平衡MVI组和非MVI组之间的偏倚。c指数Nomogram将MVI的预测模型可视化。多因素logistic回归分析发现，AFP、肿瘤大小、肿瘤边缘、肿瘤周围强化、放射学包膜等5个特征与sHCC的MVI显著相关，并将其纳入nomogram，在训练（AUC/C-index: 0.884/0.874, n=288）、验证（AUC/C-index: 0.845/0.828, n=123）和检验队列（AUC/C-index: 0.903/0.954, n=44）中具有较好的预测效果。PSM前，组织学MVI独立影响肿瘤复发（风险比：1.555,95% CI: 1.055 ~ 2.293， P=0.026）。然而，由于肿瘤大小的混杂因素，mvi阳性组和mvi阴性组之间存在显著偏倚（倾向评分：0.249±0.105比0.179±0.106，P<0.001）。同时，MVI的频率随肿瘤大小的增加而显著增加（P<0.001）。经PSM治疗后，79例MVI患者中有70例与171例非MVI患者匹配（共332例），两组间无偏倚（倾向评分：0.238±0.104∶0.217±0.109，P=0.186）。虽然非MVI组的中位复发时间仍长于MVI组（74.3个月比43.0个月，P=0.063），但MVI并不是sHCC中RFS的独立危险因素。此外，在我们的人群中，MVI不是独立的死亡率易感因素。术前模型主要基于Gd-EOB-DTPA MRI的肿瘤周围特征，在预测MVI发生方面表现出色。然而，对于≤3cm的sHCC患者，MVI是潜在的但不是独立的复发和死亡危险因素。
Whether microvascular invasion is a prognosis factor for small hepatocellular carcinoma (sHCC) is controversial, and a preoperatively predictive model based on gadoxetate disodium (Gd-EOB-DTPA) MRI is clinically needed for MVI in sHCC. Between March 2012 and September 2020, 455 consecutive patients with pathologically confirmed HCC ≤3 cm who underwent hepatectomy and preoperative Gd-EOB-DTPA MRI were retrospectively enrolled. Univariate and multivariate logistic regression combined with cox regression were conducted to find the confounding factors in the cohorts. Propensity score matching (PSM) was employed to balance the biases between MVI and non-MVI groups. Nomogram with C-index visualized the predictive model of MVI. Multivariate logistic regression identified that 5 characteristics (AFP, tumor size, tumor margin, peritumoral enhancement, radiologic capsule) were markedly associated with MVI of sHCC and incorporated into the nomogram with excellent predictive performance in the training (AUC/C-index: 0.884/0.874, n=288), validation (AUC/C-index: 0.845/0.828, n=123) and test cohorts (AUC/C-index: 0.903/0.954, n=44). Before PSM, histologic MVI independently affected tumor recurrence (hazard ratio: 1.555, 95% CI: 1.055–2.293, P=0.026). However, due to the confounder of tumor size, there was a significant bias between MVI-positive and MVI-negative groups (propensity score: 0.249±0.105 vs. 0.179±0.106, P<0.001). Meanwhile, the frequency of MVI significantly increased as tumor size growing (P<0.001). After PSM, 70 of 79 MVI cases matched with 171 non-MVI (total 332), and no biases were observed between the two groups (propensity score: 0.238±0.104 vs. 0.217±0.109, P=0.186). Although the median recurrence time in non-MVI sHCC was still longer than that in MVI group (74.3 vs. 43.0 months, P=0.063), MVI was not an independent risk factor for RFS in sHCC. Additionally, MVI was not independently vulnerable to mortality in our population. A preoperative model, mainly based on the peritumoral hallmarks of Gd-EOB-DTPA MRI, showed an excellent performance to predict the occurrence of MVI. Nevertheless, MVI was a potential but not an independent risk factor for recurrence and mortality in sHCC ≤3 cm.
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