Background
Bile duct invasion is a relatively rare event and is not well characterized in hepatocellular carcinoma (HCC). There are still very difficult to diagnose hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT) before surgery. Increasing evidences had revealed that inflammation had a critical role in tumorigenesis. The study aimed to develop the nomograms based on systemic and hepatic inflammation markers to predict microscopic bile duct tumor thrombus (micro-BDTT) before surgery in hepatocellular carcinoma (HCC).
Methods
A total of 418 cases with HCC who underwent hepatectomy as initial therapy between January 2012 and June 2020 were included in the study. Receiver operating characteristic (ROC) analysis was used to detect the optimal cut-off value of inflammation markers. Logistic regression was used to identify the independent risk factors of micro-BDTT. The Nomograms was constructed using the significant predictors including α-fetoprotein (AFP), alkaline phosphatase (ALP), direct bilirubin (DB), prognostic nutritional index (PNI), γ-glutamyl transferase (γ-GT)/alanine aminotransferase (ALT). The prediction accuracies of the nomograms were evaluated using the area under the receiver operating characteristic (ROC) curve.
Results
AFP, ALP, DB, PNI and γ-GT/ALT were the independent risk factors for predicting micro-BDTT (P = 0.043, P = 0.028, P = 0.012, P = 0.045 and P = 0.007, respectively), which were assembled into the nomograms. The area under the ROC curve of the nomograms combining PNI and γ-GT/ALT for predicting micro-BDTT were 0.809 (95% confidence intervals (CI): 0.747–0.871). The sensitivity and specificity value when used in predicting micro-BDTT before surgery were 0.778 (95% confidence intervals (CI): 0.656–0.899) and 0.724 (95% confidence intervals (CI): 0.678–0.769), respectively.
Conclusion
The nomogram based on combining systemic and hepatic inflammation markers is suitable for predicting micro-BDTT before surgery in hepatocellular carcinoma patients, leading to a rational therapeutic choice for HCC.