Preoperative Prediction Of Microvascular Invasion For Early Stage Single Hepatocellular Carcinoma

Objective To investigate the clinical relevant factors of microvascular invasion(MVI)in early stage single hepatocellular carcinoma(HCC)and establish a preoperative prediction model of MVI.Methods The clinicopathological data of patients with early stage single HCC from January 1,2012 to December 31,2017 in the People’s Hospital of Guangxi Zhuang Autonomous Region were retrospectively analyzed.According to the pathological examination results,patients were divided into MVI(+)and MVI(-)group.Comparison of eighteen preoperative factors including gender,age,neutrophil count,lymphocyte count,neutrophil/lymphocyte ratio,platelet count,alpha-fetoprotein(AFP),total bilirubin,albumin,alanine aminotransferase,aspartate aminotransferase,alpha-L-fucosidase(AFU),plasma prothrombin time,hepatitis B surface antigen,tumor diameter,tumor site,tumor margin and cirrhosis was performed between the two groups by univariate analysis.The factors which P < 0.05 in the univariate analysis were included in the multivariate Logistic Regression analysis,and then established a predictive model.The application value of the model was evaluated by ROC curve.A nomogram was made and the goodness of fit of the model was tested using the re-sampling technique.Results A total of 205 patients were included in this study.Among them,62(30.2%)cases showed MVI positive after pathological examination.The incidence of MVI was 44.9% and 21.3%,respectively,when the tumor diameter was greater than 5.5 cm and less than or equal to 5.5 cm(P < 0.001).Univariate analysis showed that preoperative AFP,AFU,tumor diameter,and tumor site were clinically relevant factors for MVI(all P < 0.001).Multivariate analysis showed that AFP(> 400 vs.≤ 400 ng/mL: OR 2.345,95%CI 1.164-4.723,P = 0.017),AFU(>27 vs.≤27 U/L: OR 3.044,95% CI 1.543-6.007,P = 0.001),tumor diameter(OR 1.138,95% CI 1.006-1.287,P = 0.039),tumor site(peripheral VS.central type: OR 2.868,95% CI 1.456-5.649,P = 0.002)were independent predictors of MVI.The area under the ROC curve of the logistic model was 0.766(95% CI 0.692-0.840),the sensitivity and specificity were 74.2% and 71.3%,respectively.The concordance index of the predicted nomogram was 0.766(95% CI 0.692-0.840),and the internal validation showed that the model fits well.Conclusion Preoperative AFP,AFU,tumor diameter and tumor site were independent predictors of MVI for early stage single HCC,and tumor diameter greater than 5.5 cm had higher risk of MVI.The nomogram model established with the combination of AFP,AFU,tumor diameter and tumor site have a certain level of predictive value of MVI for early stage single HCC and could provide a basis for assessing the risk of MVI before surgery,thus guiding preoperative treatment decisions.