Nomogram for Preoperative Estimation of Microvascular Invasion Risk in Hepatitis B Virus–Related Hepatocellular Carcinoma Within the Milan Criteria

Lei, Zhengqing; Li, Jun; Wu, Dong; Xia, Yong; Wang, Qing; Si, Anfeng; Wang, Kui; Wan, Xia; Lau, Wan Yee; Wu, Mengchao; Shen, Feng

doi:10.1001/jamasurg.2015.4257

Cited by 495 publications

(459 citation statements)

References 21 publications

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“…To evaluate the predictive accuracy of a nomogram, the C-index is widely used. The bootstrap-corrected C-index for the nomogram formulated in the present study was 0.77, which is comparable or higher than those of past studies, [33][34][35][36][37][38] suggesting the high accuracy of our nomogram for predicting 6-month survival rates. Therefore, in a heterogeneous group of patients with HCC who are referred for RT to LN metastasis, this nomogram can be used effectively to predict survival outcomes.…”

Section: Discussionsupporting

confidence: 81%

See 1 more Smart Citation

Prognostic stratification and nomogram for survival prediction in hepatocellular carcinoma patients treated with radiotherapy for lymph node metastasis

Wee

Kim

Chie

et al. 2016

BJR

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Section: Discussionsupporting

confidence: 81%

“…19,27,28,[32][33][34][35][36][37][38] However, in patients undergoing RT for LN metastasis, no prognostic grouping or nomogram has been suggested for use. In our study, a prognostic grouping by the number of risk factors was formulated based on the results of multivariate analysis.…”

Section: Discussionmentioning

confidence: 99%

Prognostic stratification and nomogram for survival prediction in hepatocellular carcinoma patients treated with radiotherapy for lymph node metastasis

Wee

Kim

Chie

et al. 2016

BJR

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“…6, 13, 14 Thus, many groups have studied noninvasive clinical predictors of MVI: larger tumor diameter, presence of multiple nodules, high level of α-fetoprotein (AFP), and thrombocytopenia. 8, 15–18 However, a nomogram based on some of these clinical predictors only predicted MVI with 57% positive predictive value (PPV) in resected tumors within Milan criteria. 15 In addition to clinical predictors of MVI, identification of MVI from preoperative computed tomography (CT) images has been attempted.…”

Section: Introductionmentioning

confidence: 99%

“…8, 15–18 However, a nomogram based on some of these clinical predictors only predicted MVI with 57% positive predictive value (PPV) in resected tumors within Milan criteria. 15 In addition to clinical predictors of MVI, identification of MVI from preoperative computed tomography (CT) images has been attempted. Qualitative radiographic descriptors such as nonsmooth tumor margin and peritumoral enhancement have some association with MVI.…”

Section: Introductionmentioning

confidence: 99%

Preoperative Prediction of Microvascular Invasion in Hepatocellular Carcinoma Using Quantitative Image Analysis

Zheng

Chakraborty

Chapman

et al. 2017

Journal of the American College of Surgeons

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Background Microvascular invasion (MVI) is a significant risk factor for early recurrence after resection or transplantation for hepatocellular carcinoma (HCC). Knowledge of MVI status would help guide treatment recommendations but is generally identified after surgery. This study aims to predict MVI preoperatively using quantitative image analysis. Study Design From 2 institutions, 120 patients submitted to resection of HCC from 2003 to 2015 were included. The largest tumor from preoperative CT was subjected to quantitative image analysis, which uses an automated computer algorithm to capture regional variation in CT enhancement patterns. Quantitative imaging features by automatic analysis, qualitative radiographic descriptors by 2 radiologists, and preoperative clinical variables were included in multivariate analysis to predict histologic MVI. Results Histologic MVI was identified in 19 (37%) patients with tumors ≤5 cm and 34 (49%) patients with tumors > 5 cm. Among patients with ≤5 cm tumors, none of clinical findings or radiographic descriptors was associated with MVI; however, quantitative feature based on angle co-occurrence matrix predicted MVI with area under curve (AUC) 0.80, positive predictive value (PPV) 63% and negative predictive value (NPV) 85%. In patients with > 5 cm tumors, higher α-fetoprotein (AFP) level, larger tumor size, and viral hepatitis history were associated with MVI, whereas radiographic descriptors did not. However, a multivariate model combining AFP, tumor size, hepatitis status, and quantitative feature based on local binary pattern predicted MVI with AUC 0.88, PPV 72% and NPV 96%. Conclusions This study reveals the potential importance of quantitative image analysis as a predictor of MVI.

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“…To this end, it is likely that antiviral therapy can help to prevent late rather than early HCC recurrences [50,51] . HBV replication and high viral load has been associated with vascular invasion, although this has not been consistently shown [52] . Even for patients with low viral load, those with high levels of HBsAg may be at increased risk of HCC recurrence [53,54] .…”

Section: Antiviral Therapy For Hcc Patients Undergoing Surgical Resecmentioning

confidence: 99%

The role of oral antiviral therapy in hepatitis B-related hepatocellular carcinoma

Fung¹,

Chok²

2017

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Hepatitis B virus (HBV) is the leading cause of hepatocellular carcinoma (HCC) in places where chronic hepatitis B infection is endemic. Oral nucleos(t)ide analog (NA) therapy can reduce the risk of HCC, but cannot completely prevent its development. For HBV-related HCCs, viral inhibition by NAs can preserve or improve liver function, thereby increasing the chance of therapeutic intervention. After surgical resection, NAs can prevent reactivation of HBV, and also reduce the chance of de novo development of HCC in the remnant liver. For those who undergo liver transplantation, NAs are essential to prevent reactivation and graft hepatitis, but is not likely to prevent HCC recurrence, which is due to metastatic disease. The role of NAs for non-curable advanced HCC is less well defined. These include patients undergoing locoregional therapy, chemotherapy, or palliation. Although antiviral therapy can preserve liver function, which may be compromised by HBV, it is unable to prevent disease progression from HCC. At the time of HCC diagnosis, most patients will already be receiving NAs, and these patients should be maintained on therapy. For patients not on antiviral therapy at the time of HCC diagnosis, the decision to commence therapy is often determined by the stage of HCC and life expectancy. Patients undergoing curative therapy, or locoregional therapy/chemotherapy with reasonable life expectancy, should be commenced on antiviral therapy. Key words:Antiviral therapy, hepatitis B virus, hepatocellular carcinoma ABSTRACTArticle history:

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Nomogram for Preoperative Estimation of Microvascular Invasion Risk in Hepatitis B Virus–Related Hepatocellular Carcinoma Within the Milan Criteria

Abstract: The nomogram achieved an optimal preoperative prediction of MVI in HBV-related HCC within the Milan criteria. Using the model, the risk for an individual patient to harbor MVI can be determined, which can lead to a rational therapeutic choice.

Cited by 495 publications

References 21 publications

Prognostic stratification and nomogram for survival prediction in hepatocellular carcinoma patients treated with radiotherapy for lymph node metastasis

Prognostic stratification and nomogram for survival prediction in hepatocellular carcinoma patients treated with radiotherapy for lymph node metastasis

Preoperative Prediction of Microvascular Invasion in Hepatocellular Carcinoma Using Quantitative Image Analysis

The role of oral antiviral therapy in hepatitis B-related hepatocellular carcinoma

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