A Novel Online Calculator to Predict Risk of Microvascular Invasion in the Preoperative Setting for Hepatocellular Carcinoma Patients Undergoing Curative-Intent Surgery

Background The presence of microvascular invasion (MVI) has been highlighted as an important determinant of hepatocellular carcinoma (HCC) prognosis. We sought to build and validate a novel model to predict MVI in the preoperative setting. Methods Patients who underwent curative-intent surgery for H...

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Published in:Annals of surgical oncology 2023-02, Vol.30 (2), p.725-733
Main Authors: Endo, Yutaka, Alaimo, Laura, Lima, Henrique A., Moazzam, Zorays, Ratti, Francesca, Marques, Hugo P., Soubrane, Olivier, Lam, Vincent, Kitago, Minoru, Poultsides, George A., Popescu, Irinel, Alexandrescu, Sorin, Martel, Guillaume, Workneh, Aklile, Guglielmi, Alfredo, Hugh, Tom, Aldrighetti, Luca, Endo, Itaru, Pawlik, Timothy M.
Format: Article
Language:English
Subjects:
Carcinoma, Hepatocellular - pathology
Hepatectomy
Hepatobiliary Tumors
Hepatocellular carcinoma
Humans
Leukocytes (neutrophilic)
Liver cancer
Liver Neoplasms - pathology
Lymphocytes
Medical prognosis
Medicine
Medicine & Public Health
Microvasculature
Multivariate analysis
Neoplasm Invasiveness
Oncology
Prediction models
Retrospective Studies
Surgery
Surgical Oncology
Tumors
α-Fetoprotein
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Summary:Background The presence of microvascular invasion (MVI) has been highlighted as an important determinant of hepatocellular carcinoma (HCC) prognosis. We sought to build and validate a novel model to predict MVI in the preoperative setting. Methods Patients who underwent curative-intent surgery for HCC between 2000 and 2020 were identified using a multi-institutional database. Preoperative predictive models for MVI were built, validated, and used to develop a web-based calculator. Results Among 689 patients, MVI was observed in 323 patients (46.9%). On multivariate analysis in the test cohort, preoperative parameters associated with MVI included α-fetoprotein (AFP; odds ratio [OR] 1.50, 95% confidence interval [CI] 1.23–1.83), imaging tumor burden score (TBS; hazard ratio [HR] 1.11, 95% CI 1.04–1.18), and neutrophil-to-lymphocyte ratio (NLR; OR 1.18, 95% CI 1.03–1.35). An online calculator to predict MVI was developed based on the weighted β-coefficients of these three variables ( https://yutaka-endo.shinyapps.io/MVIrisk/ ). The c-index of the test and validation cohorts was 0.71 and 0.72, respectively. Patients with a high risk of MVI had worse disease-free survival (DFS) and overall survival (OS) compared with low-risk MVI patients (3-year DFS: 33.0% vs. 51.9%, p  
ISSN:1068-9265
1534-4681
DOI:10.1245/s10434-022-12494-0