Preoperative Prediction Of Hepatocellular Carcinoma With Portal Vein Tumor Thrombus Based On Conventional Data

Hepatocellular carcinoma?HCC?has a high predilection with portal vein tumor thrombosis?PVTT?.Once the occurrence of PVTT is confirmed,it will have a great impact on the treatment choice and prognosis of HCC patients.Clinically,PVTT is usually diagnosed by imaging methods.However,the diagnosis of PVTT must be made through postoperative pathological diagnosis,especially for the microscopic portal vein carcinoma thrombi?we call them type I₀?,which is difficult to be diagnosed preoperatively.Therefore,it is necessary to find a way to diagnose the occurrence of PVTT preoperatively.Objective:The objective of this study was to establish a simple and inexpensive non-invasive model to predict the presentation of PVTT at HCC patients.Methods:A total of815 HCC patients were retrospectively evaluated and randomly assigned into 2groups:the training group?n=408?and validation group?n=407?.A new index model,namely W?AL,was built to predict the presence of PVTT in the training subjects and was further validated in the validation subjects.Results:At the optimal cutoff of 8.90,W?AL identified patients with a hazard ratio?HR?of7.139 for the presence of PVTT.The area under receiver operating characteristic?AUROC?of W?AL was 0.795?sensitivity:71.9%;specificity:78.6%?for differentiation between PVTT and non-PVTT patients in the training group.The AUROC of W?AL in differentiating patients with PVTT type I₀from non-PVTT patients was 0.748?sensitivity:72.1%;specificity:68.4%?with an HR of 5.355.In addition,W?AL>8.90 was significantly associated with large tumors,multiple tumor numbers,TNM stage III-IV,metastasis,and overall survival in HCC patients.Conclusions:The novel predictive model represents a simple and inexpensive model that can identify the presence of PVTT in HCC patients with a high degree of accuracy,with important clinical significance in the future therapeutic management of HCC patients.