A pre-operative clinical model to predict microvascular invasion and long-term outcome after resection of hepatocellular cancer: The Australian experience

Schlichtemeier, Steven; Pang, Tony; Williams, Nigel; Gill, Anthony J.; Smith, Ross C.; Samra, Jaswinder S.; Lam, Vincent; Hollands, Michael; Richardson, A. J.; Pleass, Henry; Nozawa, Shiro; Albania, Maria; Hugh, Tom

doi:10.1016/j.ejso.2016.05.032

Cited by 35 publications

(29 citation statements)

References 49 publications

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“…In previous studies, multifocal lesions, large tumor size, advanced neoplasm grade, and high serum AFP level have been reported to increase the possibility of vascular invasion in advanced HCC (33)(34)(35). In the present study, abnormal AFP level, an independent risk factor for MVI, was also significantly associated with MVI.…”

Section: Discussionsupporting

confidence: 67%

A radiomics nomogram for preoperative prediction of microvascular invasion risk in hepatitis B virus-related hepatocellular carcinoma

Peng

Zhang

et al. 2018

Diagn Interv Radiol

159

124

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H epatocellular carcinoma (HCC) is the sixth most common type of cancer and ranks third as a cause of cancer-related death globally. Worldwide, approximately 630 000 new cases of HCC occur annually, with more than half of these cases occurring in China (1). This disease is related to hepatitis B virus (HBV) infection in almost 70%-90% of cases in the highly endemic Asia-Pacific regions, especially in China (2, 3). Partial hepatectomy and liver transplantation are the most effective curative treatments, albeit in a limited number of cases (4). Indeed, the 5-year recurrence rates after surgical treatment and liver transplantation are as high as 70% and 35%, respectively (5-7). It is, therefore, necessary to find effective biomarkers that can identify aggressive behavior and predict tumor recurrence after liver resection and transplantation.In HCC, the presence of microvascular invasion (MVI) is a histopathologic feature indicative of aggressive behavior (8). Previous studies have identified MVI as a major risk factor for early recurrence in the first two years after liver resection and transplantation (9). Precise identification of MVI involvement in patients with HCC is critical to develop treatment strategies and arrive at prognoses. Over the past decade, researchers have made persistent endeavors towards the preoperative prediction of MVI (10-12). Although several radiologic features on contrast-enhanced magnetic resonance imaging (MRI) and computed tomography (CT) images (such as tumor margin, internal arteries, and hypodense halos) are known PURPOSE We aimed to develop and validate a radiomics nomogram for preoperative prediction of microvascular invasion (MVI) in hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). METHODSA total of 304 eligible patients with HCC were randomly divided into training (n=184) and independent validation (n=120) cohorts. Portal venous and arterial phase computed tomography data of the HCCs were collected to extract radiomic features. Using the least absolute shrinkage and selection operator algorithm, the training set was processed to reduce data dimensions, feature selection, and construction of a radiomics signature. Then, a prediction model including the radiomics signature, radiologic features, and alpha-fetoprotein (AFP) level, as presented in a radiomics nomogram, was developed using multivariable logistic regression analysis. The radiomics nomogram was analyzed based on its discrimination ability, calibration, and clinical usefulness. Internal cohort data were validated using the radiomics nomogram. RESULTSThe radiomics signature was significantly associated with MVI status (P < 0.001, both cohorts). Predictors, including the radiomics signature, nonsmooth tumor margin, hypoattenuating halos, internal arteries, and alpha-fetoprotein level were reserved in the individualized prediction no- CONCLUSIONThe radiomics nomogram, as a noninvasive preoperative prediction method, shows a favorable predictive accuracy for MVI status in patients with HBV-related HCC.

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Section: Discussionsupporting

confidence: 67%

A radiomics nomogram for preoperative prediction of microvascular invasion risk in hepatitis B virus-related hepatocellular carcinoma

Peng

Zhang

et al. 2018

Diagn Interv Radiol

159

124

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“…The long‐term survival outcomes of patients with HCC with MVI can vary greatly after R0 LR . Whether postoperative adjuvant therapy should be performed for all these patients is controversial.…”

Section: Discussionmentioning

confidence: 99%

An Eastern Hepatobiliary Surgery Hospital Microvascular Invasion Scoring System in Predicting Prognosis of Patients with Hepatocellular Carcinoma and Microvascular Invasion After R0 Liver Resection: A Large-Scale, Multicenter Study

et al. 2019

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Background. Microvascular invasion (MVI) is associated with poor postoperative survival outcomes in patients with hepatocellular carcinoma (HCC). An Eastern Hepatobiliary Surgery Hospital (EHBH) MVI scoring system was established to predict prognosis in patients with HCC with MVI after R0 liver resection (LR) and to supplement the most commonly used classification systems. Materials and Methods. Patients with HCC with MVI who underwent R0 LR as an initial therapy were included. The EHBH-MVI score was developed from a retrospective cohort from 2003 to 2009 to form the training cohort. The variables associated with overall survival (OS) on univariate analysis were subsequently investigated using the log-rank test, and the EHBH-MVI score was developed using the Cox regression model. It was validated using an internal prospective cohort from 2011 to 2013 as well as three independent external validation cohorts.Results. There were 1,033 patients in the training cohort; 322 patients in the prospective internal validation cohort; and 493, 282, and 149 patients in the three external validation cohorts, respectively. The score was developed using the following factors: α-fetoprotein level, tumor encapsulation, tumor diameter, hepatitis B e antigen positivity, hepatitis B virus DNA load, tumor number, and gastric fundal/esophageal varicosity. The score differentiated two groups of patients (≤4, >4 points) with distinct long-term prognoses outcomes (median OS, 55.8 vs. 19.6 months; p < .001). The predictive accuracy of the score was greater than the other four commonly used staging systems for HCC. Conclusion. The EHBH-MVI scoring system was more accurate in predicting prognosis in patients with HCC with MVI after R0 LR than the other four commonly used staging systems. The score can be used to supplement these systems. The Oncologist 2019;24:e1476-e1488 Implications for Practice: Microvascular invasion (MVI) is a major determinant of survival outcomes after curative liver resection for patients with hepatocellular carcinoma (HCC). Currently, there is no scoring system aiming to predict prognosis of patients with HCC and MVI after R0 liver resection (LR). Most of the widely used staging systems for HCC do not use MVI as an independent risk factor, and they cannot be used to predict the prognosis of patients with HCC and MVI after surgery. In this study, a new Eastern Hepatobiliary Surgery Hospital (EHBH) MVI scoring system was established to predict prognosis Hepatobiliary of patients with HCC and MVI after R0 LR. Based on the results of this study, postoperative adjuvant therapy may be recommended for patients with HCC and MVI with an EHBH-MVI score >4. This score can be used to supplement the currently used HCC classifications to predict postoperative survival outcomes in patients with HCC and MVI. SI conversion factors: To convert albumin to grams per liter, multiply by 10; α-fetoprotein to micrograms per milliliter, multiply by 1; alanine aminotransferase to microkatals per liter, multiply by 0.0167; creatinine to micro...

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“…30 Now tumor size was widely accepted as a risk factor for MVI while the tumor size cut-off value for predicting MVI is still controversial. [31][32][33][34][35][36][37][38][39] Our study analyzed tumor size as a continuous variable, which can keep more information compared to other studies regarding tumor size as a discontinuous variable. As for AFP, due to the significant variation, we turned it into a discontinuous variable based on the maximum of Youden index.…”

Section: Discussionmentioning

confidence: 99%

<p>Nomogram For Preoperative Prediction Of Microvascular Invasion Risk In Hepatocellular Carcinoma</p>

Deng¹,

Yao²,

Zeng³

et al. 2019

CMAR

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To preoperatively predict the microvascular invasion (MVI) risk in hepatocellular carcinoma (HCC) using nomogram. Methods: A retrospective cohort of 513 patients with HCC hospitalized at Xiangya Hospital between January 2014 and December 2018 was included in the study. Univariate and multivariate analysis was performed to identify the independent risk factors for MVI. Based on the independent risk factors, nomogram was established to preoperatively predict the MVI risk in HCC. The accuracy of nomogram was evaluated by using receiver operating characteristic (ROC) curve, calibration curve and decision curve analysis (DCA). Results: Tumor size (OR=1.17, 95% CI: 1.11-1.23, p<0.001), preoperative AFP level greater than 155 ng/mL (OR=1.65, 95% CI: 1.13-2.39, p=0.008) and NLR (OR=1.14, 95% CI: 1.00-1.29, p=0.042) were the independent risk factors for MVI. Incorporating these 3 factors, nomogram was established with the concordance index of 0.71 (95% CI, 0.66-0.75) and well-fitted calibration curves. DCA confirmed that using this nomogram added more benefit compared with the measures that treat all patients or treat none patients. At the cutoff value of predicted probability ≥0.44, the model demonstrated sensitivity of 61.64%, specificity of 71.53%, positive predictive value (PPV) of 64.13%, and negative predictive value (NPV) of 69.31%. Conclusion: Nomogram was established for preoperative prediction of the MVI risk in HCC patients, and better therapeutic choice will be made if it was applied in clinical practice.

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A pre-operative clinical model to predict microvascular invasion and long-term outcome after resection of hepatocellular cancer: The Australian experience

Cited by 35 publications

References 49 publications

A radiomics nomogram for preoperative prediction of microvascular invasion risk in hepatitis B virus-related hepatocellular carcinoma

A radiomics nomogram for preoperative prediction of microvascular invasion risk in hepatitis B virus-related hepatocellular carcinoma

An Eastern Hepatobiliary Surgery Hospital Microvascular Invasion Scoring System in Predicting Prognosis of Patients with Hepatocellular Carcinoma and Microvascular Invasion After R0 Liver Resection: A Large-Scale, Multicenter Study

<p>Nomogram For Preoperative Prediction Of Microvascular Invasion Risk In Hepatocellular Carcinoma</p>

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