Risk Prediction Of Preoperative Microvascular Invasion In Hepatocellular Carcinoma And Analysis Of Risk Factors For Early Recurrence After Hepatectomy

Part 1.Risk prediction of microvascular invasion in hepatocellular carcinoma preoperatively based on MRI featuresObjective This study aimed to investigate the risk factors of microvascular invasion(MVI)in patients with hepatocellular carcinoma(HCC)by analyzing the preoperative clinical data and tumor MRI characteristics,and the value of establishing a preoperative risk prediction scoring model based on this.Methods The clinical and imaging data of 232 patients with single HCC who underwent surgical resection in General Hospital of Ningxia Medical University from January 2016 to July2020 were retrospectively analyzed.According to different time periods,they were divided into derivation(n=162)and validation cohort(n=70)in a ratio of 7:3.Univariate analysis and multivariate logistic regression analysis were performed on the clinical data and tumor MRI characteristics of HCC patients in derivation cohort,to identify independent risk factors for predicting MVI,and thus establish a preoperative risk prediction scoring model.The data of HCC patients in the validation cohort were used to verify and evaluate the preoperative risk prediction scoring model.Results Univariate logistic regression analysis showed that higher AST,NLR and PLR in preoperative laboratory indicators of HCC patients were risk factors for MVI(P<0.05).Tumor dimension,DWI/T2 WI mismatch,tumor irregular margin,peritumoral enhancement,intratumoral arteries,mosaic architecture,tumor incomplete capsule,the tumor protrudes beyond the contour of the liver,tumor atypical enhancement,the low mean ADC values in the preoperative MRI features of HCC patients were risk factors for MVI(P<0.05).Multivariate Logistic regression analysis showed that DWI/T2 WI mismatch(P=0.031),tumor irregular margin(P=0.044)and tumor incomplete capsule(P=0.004)were independent risk factors for predicting MVI.The area under receiver operating characteristic of the preoperative risk prediction scoring model constructed by this method was 0.881(95%CI,0.820~0.926)and0.902(95%CI,0.808~0.960)in the derivation and validation cohorts.The sensitivity was 88.3%and 83.7%,and the specificity was 77.9% and 90.5%,respectively.The predictive cut-off score was 2,when a score of ≤ 2 defined as low risk of MVI(n=76)and a score of > 2 as high risk of MVI(n=86).Conclusion The preoperative risk prediction score model based on MRI features has certain clinical significance and reference value for the preoperative evaluation of MVI in HCC patients.Part 2.Analysis of risk factors for early recurrence of hepatocellular carcinoma after hepatectomyObjective To investigate the value of clinicopathological features and tumor MRI features in assessing the risk of early recurrence after hepatectomy in HCC patients.Methods The clinical,pathological and imaging data of 105 patients with single HCC without macrovascular invasion who underwent surgical resection in General Hospital of Ningxia Medical University from January 2016 to December 2018 were retrospectively analyzed.The patients were divided into two groups: early recurrence group(n=65)and nonearly recurrence group(n=65).Univariate analysis and multivariate survival analysis were performed on the clinicopathological data and MRI features of the two groups of HCC patients to determine the independent risk factors for early postoperative recurrence,then evaluate the recurrence-free survival between different risk factors groups with Kaplan-Meier method.Results Univariate survival analysis showed that higher AST,PLR,and ALBI scores in preoperative laboratory indicators were risk factors for early recurrence after hepatectomy in HCC patients(P<0.05).Tumor dimension ≥ 5cm,DWI/T2 WI mismatch,tumor irregular margin,intratumoral arteries,mosaic architecture,tumor incomplete capsule and tumor atypical enhancement in preoperative MRI features were risk factors for early recurrence after hepatectomy in HCC patients(P<0.05).The presence of MVI and the tumor was moderately or poorly differentiated in postoperative pathological features were risk factors for early recurrence after hepatectomy in HCC patients(P<0.05).Multivariate survival analysis showed that preoperative higher ALBI grade(P=0.004),tumor mosaic structure in preoperative MRI images(P=0.009)and MVI in postoperative pathology(P=0.008)were independent risk factors for early recurrence after hepatectomy in single HCC patients without macrovascular invasion.Conclusion The clinicopathological features and MRI features of HCC has some value in evaluating the risk of early recurrence after hepatectomy.