Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 14, 2020; 26(14): 1647-1659
Published online Apr 14, 2020. doi: 10.3748/wjg.v26.i14.1647
Development and validation of a prediction model for microvascular invasion in hepatocellular carcinoma
Lin Wang, Yue-Xinzi Jin, Ya-Zhou Ji, Yuan Mu, Shi-Chang Zhang, Shi-Yang Pan
Lin Wang, Yue-Xinzi Jin, Ya-Zhou Ji, Yuan Mu, Shi-Chang Zhang, Shi-Yang Pan, Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
Lin Wang, Yue-Xinzi Jin, Ya-Zhou Ji, Yuan Mu, Shi-Chang Zhang, Shi-Yang Pan, National Key Clinical Department of Laboratory Medicine, Jiangsu Province Hospital, Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
Author contributions: Wang L and Pan SY designed the study and wrote the paper; Jin YXZ and Ji YZ collected the clinical data; Wang L, Mu Y, and Zhang SC contributed to data analysis and validation.
Supported by the National Natural Science Foundation of China, No. 81672100; and the Key Laboratory for Laboratory Medicine of Jiangsu Province of China, No. ZDXKB2016005.
Institutional review board statement: This study was reviewed and approved by the Institutional Ethics Committee of the First Affiliated Hospital of Nanjing Medical University.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: We have no financial relationships to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Shi-Yang Pan, MD, PhD, Professor, Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing 210029, Jiangsu Province, China. sypan@njmu.edu.cn
Received: December 19, 2019
Peer-review started: December 19, 2019
First decision: January 19, 2020
Revised: March 14, 2020
Accepted: March 19, 2020
Article in press: March 19, 2020
Published online: April 14, 2020
Abstract
BACKGROUND

Microvascular invasion (MVI) is an important prognostic factor affecting early recurrence and overall survival in hepatocellular carcinoma (HCC) patients after hepatectomy and liver transplantation, but it can be determined only in surgical specimens. Accurate preoperative prediction of MVI is conducive to clinical decisions.

AIM

To develop and validate a preoperative prediction model for MVI in patients with HCC.

METHODS

Data from 454 patients with HCC who underwent hepatectomy at the First Affiliated Hospital of Nanjing Medical University between May 2016 and October 2019 were retrospectively collected. Then, the patients were nonrandomly split into a training cohort and a validation cohort. Logistic regression analysis was used to identify variables significantly associated with MVI that were then included in the nomogram. We evaluated the discrimination and calibration ability of the nomogram by using R software.

RESULTS

MVI was confirmed in 209 (46.0%) patients by a pathological examination. Multivariate logistic regression analysis identified four risk factors independently associated with MVI: Tumor size [odds ratio (OR) = 1.195; 95% confidence interval (CI): 1.107–1.290; P < 0.001], number of tumors (OR = 4.441; 95%CI: 2.112–9.341; P < 0.001), neutrophils (OR = 1.714; 95%CI: 1.036–2.836; P = 0.036), and serum α-fetoprotein (20–400 ng/mL, OR = 1.955; 95%CI: 1.055–3.624; P = 0.033; >400 ng/mL, OR = 3.476; 95%CI: 1.950–6.195; P < 0.001). The concordance index was 0.79 (95%CI: 0.74–0.84) and 0.81 (95%CI: 0.74–0.89) in the training and validation cohorts, respectively. The calibration curves showed good agreement between the predicted risk by the nomogram and real outcomes.

CONCLUSION

We have developed and validated a preoperative prediction model for MVI in patients with HCC. The model could aid physicians in clinical treatment decision making.

Keywords: Microvascular invasion, Nomogram, Hepatocellular carcinoma, Discrimination and calibration, Neutrophils, Early recurrence

Core tip: Microvascular invasion (MVI) is an established risk factor for early recurrence and a poor prognosis in patients with hepatocellular carcinoma, but it can be confirmed only by postoperative pathology. Our study identified four predictors independently related to MVI based mainly on laboratory parameters and established a nomogram to predict the presence of MVI preoperatively. The model showed good performance in the evaluation of discrimination and calibration ability and could help optimize treatment options in the clinic.