Nomogram Based On Inflammatory Markers For The Preoperative Prediction Of Microvascular Invasion In Solitary Primary Hepatocellular Carcinoma

Background and ObjectiveHepatocellular carcinoma(HCC)is the sixth most common malignant tumor in the world and the leading cause of cancer-related death.Surgical resection is the first choice for the treatment of HCC,but due to the generally high recurrence rate and metastasis rate,the recurrence rate 5 years after resection is more than 50%.Microvascular invasion(MVI)is a key factor affecting early recurrence and long-term survival of HCC.At present,histopathological examination of surgical specimens after hepatectomy is the gold standard for the diagnosis of MVI.Accurate preoperative evaluation of MVI can help surgeons choose an accurate method of operation and improve the prognosis of patients.In recent years,many studies have found some indicators that can be used for preoperative prediction of MVI,but a unified standard has not been formed yet.Nomogram is an effective tool to synthesize and quantify the important risk factors affecting the prognosis of the disease.The purpose of our study is to explore new indicators for predicting MVI and to develop a new predictive model using nomogram to predict the risk of MVI in solitary HCC before operation.MethodsData from 567 patients with solitary primary HCC who underwent hepatectomy at the First Affiliated Hospital of Zhengzhou University from January 2017 to March 2022 were retrospectively analyzed.Patients were divided into training(n=441)and validation(n=126)cohorts according to surgical data.Independent risk factors for MVI were identified via univariate and multivariate logistic regression analyses in the training cohort.A novel nomogram was developed based on the independent risk factors identified.Its accuracy was evaluated using a calibration curve and concordance index(C-index).The predictive value was evaluated using the receiver operating characteristic(ROC)curve and decision curve analysis(DCA).Results1.In the univariate logistic regression analysis,preoperative white blood cell(WBC)count>3.5×109/L,GGT>58 U/L,AST>40 U/L,AFP>969 μg/L;platelet>125×109/L;albumin>35 g/L,tumor size(cm),neutrophil>1.8×109/L,GPR>0.32,APR>0.18,GAR>2.30,NLR>1.98,and GLR>29.58 were identified as preoperative risk factors for MVI in patients with solitary HCC.2.The multivariate logistic regression analysis shows that preoperative AFP>969μg/L(OR=3.147,95%CI:1.905-5.199,P<0.001),tumor size(OR=1.143,95%CI:1.052-1.240,P=0.002),neutrophil>1.8×109/L(OR=3.761,95%CI:1.627-8.696,P=0.002),GPR>0.32(OR=2.637,95%CI:1.487-4.675,P=0.001),APR>0.18(OR=2.576,95%CI:1.514-4.381,P<0.001),GAR>2.30(OR=3.400,95%CI:1.600-7.226,P=0.001),and GLR>29.58(OR=7.037,95%CI:3.403-14.549,P<0.001)were identified as preoperative independent risk factors for MVI in patients with solitary HCC.3.The C-index of the training and validation cohorts were 0.788(95%CI:0.7440.831)and 0.782(95%CI:0.703-0.861)respectively.The analysis of the calibration curves for the training and validation cohorts showed that the standard curve fit well with the predicted curve,indicating agreement between the observed frequency and predicted probability of MVI.The ROC curve analysis indicating that the nomogram had a high prediction accuracy for MVI.DCA revealed that the novel nomogram has notable clinical applicationConclusionPreoperative GPR>0.32,APR>0.18,and GAR>2.30 were independent risk factors for MVI in patients with solitary primary HCC.The novel nomogram developed and validated in this study has good accuracy and clinical application value,and can provide a new choice and reference for clinical application.