A preoperative model for predicting microvascular invasion and assisting in prognostic stratification in liver transplantation for HCC regarding empirical criteria

• Main Authors: Wenhui Zhang, Zhikun Liu, Junli Chen, Siyi Dong, Beini Cen, Shusen Zheng, Xiao Xu
• Format: Article
• Language: English
• Published: Elsevier 2021-11-01
• Series: Translational Oncology
• Subjects: Microvascular Invasion (MVI); Liver Transplantation (LT); Hepatocellular Carcinoma (HCC)
• Online Access: http://www.sciencedirect.com/science/article/pii/S1936523321001923

Purpose: The prediction of microvascular invasion (MVI) has increasingly been recognized to reflect prognosis involving local invasion and distant metastasis of hepatocellular carcinoma (HCC). The aim of this study was to assess a predictive model using preoperatively accessible clinical parameters and radiographic features developed and validated to predict MVI. This predictive model can distinguish clinical outcomes after liver transplantation (LT) for HCC patients. Methods: In total, 455 HCC patients who underwent LT between January 1, 2015, and December 31, 2019, were retrospectively enrolled in two centers in China as a training cohort (ZFA center; n = 244) and a test cohort (SLA center; n = 211). Univariate and multivariate backward logistic regression analysis were used to select the significant clinical variables which were incorporated into the predictive nomogram associated with MVI. Receiver operating characteristic (ROC) curves based on clinical parameters were plotted to predict MVI in the training and test sets. Results: Univariate and multivariate backward logistic regression analysis identified four independent preoperative risk factors for MVI: α-fetoprotein (AFP) level (p < 0.001), tumor size ((p < 0.001), peritumoral star node (p = 0.003), and tumor margin (p = 0.016). The predictive nomogram using these predictors achieved an area under curve (AUC) of 0.85 and 0.80 in the training and test sets. Furthermore, MVI could discriminate different clinical outcomes within the Milan criteria (MC) and beyond the MC. Conclusions: The nomogram based on preoperatively clinical variables demonstrated good performance for predicting MVI. MVI may serve as a supplement to the MC.