Analysis Of Risk Factors For Hepatocellular Carcinoma With Microvascular Invasion And Establishment Of Nomogram

Objective:Hepatocellular carcinoma(HCC)is a kind of malignant tumor with high recurrence rate.The occurrence of microvascular invasion(MVI)is a high risk factor of recurrence and metastasis in HCC patients,and also an important factor affecting the long-term survival of HCC patients.The prognosis of patients with MVI is better.MVI evaluation of HCC patients before operation can help to judge the prognosis and guide the operation strategy,but there is no uniform and accurate prediction index and method.In this study,we analyzed the clinicopathological data of HCC patients,counted the clinical indicators of MVI in HCC patients,found the related risk factors,and established a simple and feasible prediction model based on these factors,hoping to guide the treatment of HCC patients with MVI.Methods:The clinical data of HCC patients admitted to the First Affiliated Hospital of Zhengzhou University from June 2018 to December 2019 were statistically analyzed through the case management system.The patients who had undergone radical resection of liver cancer in our hospital were included in the study.A total of 264 cases were statistically analyzed.182 cases from June 2018 to July 2019 were taken as the model group,and 82 cases from August 2019 to December 2019 were divided into validation group.The patients were divided into two groups according to whether there was MVI or not.The risk factors of HCC patients in the model group were analyzed.The best critical value of each clinical index in the model group to predict MVI was determined by receiver operating characteristic(ROC),and the data were divided in detail.The results of single factor analysis were obtained by χ2 test,the related factors in single factor analysis were analyzed by multi factor Logistic regression model,and then the independent risk factors of MVI in HCC patients were obtained.Ratio(OR)and 95%confidence interval(95%CI)were used to evaluate the correlation between clinical indicators and MVI.After the independent risk factors were obtained,R3.6 software was used in the combination of multiple factors on the basis of this,a nomogram is established,and c-index is used to describe the prediction effect of the model.The difference was statistically significant(P<0.05).Results:1.In this study,ROC curve was used to predict the best critical value of each preoperative index in the model group:fibrinogen was 3.075 g/L,neutrophil was 2.12×109/L,lymphocyte was 0.48×109/L,NLR was 1.627,PLT was 239.5×109/L,far was 0.0650,PLR was 104.741,INR was 1.025.2.The analysis results of the single factor model in this study show that:In the model group,postoperative Edmondson-Steiner pathological grade,multiple tumor number,maximum tumor diameter of>5 cm,preoperative biochemical indexes AST>40 U/L,TBil>25μmol/L,Alb≤35 g/L,preoperative tumor markers AFP>20μg/L,preoperative inflammation-related indexes FAR>0.065,PLR>104.741,NLR>1.627,and preoperative coagulation function indexes INR>1.025 were closely related to the occurrence of MVI.3.In this study,multivariate Logistic regression analysis showed that:In the model group,the maximum tumor diameter was>5 cm(OR=3.549,95%CI:1.628～7.373,P=0.001),the number of tumors was multiple(OR=3.723,95%CI:1.342～10.325,P=0.012),the preoperative inflammation-related index NLR>1.627(OR=3.620,95%CI:1.338～9.798,P=0.011),and the preoperative coagulation function index INR>1.025(OR=3.094,95%CI:1.446～6.617,P=0.004)and the preoperative tumor marker AFP>20μg/L(OR=3.313,95%CI:1.471～7.464,P=0.004)were independent risk factors for the development of HCC MVI.4.In this study,the c-index of the model group was 0.812,and the c-index of the validation group was 0.836.The prediction effect of the model was good.Conclusion:1.Preoperative maximum tumor diameter,multiple tumor number,preoperative coagulation function index INR,preoperative tumor marker AFP,and preoperative inflammation-related index NLR were independent risk factors for microvascular invasion in HCC patients.2.The multi-factor prediction model based on tumor diameter greater than 5cm,multiple tumor focus,preoperative INR greater than 1.025,preoperative AFP greater than 20 μg/L and NLR greater than 1.627,it has a better prediction effect for MVI phenomenon,and can be used as a reference for the treatment of liver cancer.