Preoperative CT-based Signatures:Nomogram Prediction Of Individual Prognosis Of Patients With HBV-related Solitary Hepatocellular Carcinoma After Curative Resection

Part 1 Preoperative computed tomography to predict microvascularinvasion in HBV-related solitary hepatocellular carcinomaObjective: To determine the diagnostic value of multiphasic computed tomography(CT)for prediction of microvascular invasion(MVI)in hepatocellular carcinoma(HCC).Methods: Preoperative multiphasic CTs for 160 patients with 57MVI-positive and 103 MVI-negative HCCs diagnosed by surgical pathology were reviewed retrospectively.Tumor size,grade,margins,capsule,necrosis,peritumoral enhancement,tumor enhanced ratio,capsular invasion,and serum alpha-fetoprotein(AFP)level were analyzed in SPSS 16.0.Results: Univariate analysis showed that capsular invasion,margins,tumor size,grade,peritumoral enhancement and serum AFP level were associated withMVI(P < 0.05).Conclusion: Radiographic hepatic capsular invasion and non-smooth tumor margins identified by preoperative multiphasic CT images,along with AFP levels greater than 232.2 ng/ml,are important predictors of MVI.Part 2 Validated preoperative computed tomography risk estimation for postoperative HBV-related solitary hepatocellular carcinoma recurrenceObjective: To develop and validate a risk estimation of tumor recurrence following curative resection of operable HBV-related solitary hepatocellular carcinoma(HCC).Methods: Data for 128 patients with operable HCC(according to Barcelona Clinic Liver Cancer imaging criteria)who underwent preoperative computed tomography(CT)evaluation at our hospital from May 1,2013 through May 30,2014 were included in this study.Follow-up data were obtained from hospital medical records.Follow-up data through May 30,2016 were used to retrospectively analyze preoperative multiphasic CT findings,surgical histopathology results,and serum ?-fetoprotein and thymidine kinase-1 levels.The ?2 test,independent t-test,and Mann-Whitney U test were used to analyze data.A P value of < 0.05 was considered statistically significant.Results: During the follow-up period,38 of 128 patients(29.7%)had a postoperative HCC recurrence.Microvascular invasion(MVI)was associated with HCC recurrence(?2 = 13.253,P < 0.001).Despite postoperative antiviral therapy and chemotherapy,22 of 44 patients with MVI experienced recurrence after surgical resection.The presence of MVI was 57.9% sensitive,75.6%specific and 70.3% accurate in predicting postoperative recurrence.Of 84 tumors without MVI,univariate analysis confirmed that tumor margins,tumor margin grade,and tumor capsule detection on multiphasic CT were associated with HCC recurrence(P < 0.05).Univariate analyses showed no difference between groups with respect to hepatic capsular invasion,Ki-67 proliferation marker value,Edmondson-Steiner grade,largest tumor diameter,necrosis,arterial phase enhanced ratio,portovenous phase enhanced ratio,peritumoral enhancement,or serum ?-fetoprotein level.Conclusion: Non-smooth tumor margins,incomplete tumor capsules and missing tumor capsules correlated with postoperative HCC recurrence.HCC recurrence following curative resection may be predicted using CT.Part 3 Preoperative CT combined with other clinical indicators predicts survival of HBV-related hepatocellular carcinoma patients after hepatectomyObjective: The present study investigated the prognostic significance of CT combined with other clinical indicators in HBV-related hepatocellular carcinoma(HCC).Methods: Preoperative multiphasic CTs for 166 patients with operable HCC were performed in our hospital from 15 November 2013 through 15 May2015.Follow-up information,until 5 June 2017,included: CT,pathological and clinical characteristics,and recurrence and metastases of HCC confirmed by pathological or radiological diagnosis.The parameters were analyzed by the Kaplan-Meier method and Cox proportional hazards regression analysis.Results: In multivariate analyses,overall survival was not significantly associated with any of the analyzed prognostic risk factors,but did show that the following were significant prognostic risk factors for disease-free survival:larger tumor size,positive radiogenomic venous invasion,non-smooth tumor margin,and histological microvascular invasion.Conclusion: In patients with HBV-related HCC,CT signatures were a noninvasive significant indicator of disease-free survival.Part 4 Nomogram prediction of individual prognosis of patients with HBV-related hepatocellular carcinomaObjective: The purpose of this study was to develop an effective nomogram capable of estimating the individual survival outcomes of patients with HBV-related hepatocellular carcinoma(HCC).Methods: The nomogram was established based on part three.The predictive accuracy and discriminative ability of the previously developed nomogram were assessed by C-index and calibration curves.The results were validated using a bootstrap approach to correct for bias.Results: Larger tumor size,positive radiogenomic venous invasion,non-smooth tumor margin,and histological microvascular invasion were all incorporated into the nomogram.The calibration curves for predicting the probability of disease-free survival between the nomogram and actual observation showed good conformity.Conclusions: The proposed nomogram resulted in more-accurate prognostic prediction for patients with HBV-related HCC after hepatectomy.