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Predictive model for microvascular invasion of hepatocellular carcinoma among candidates for either hepatic resection or liver transplantation.

Abstract：

BACKGROUND:Microvascular invasion is the strongest prognostic factor of survival in patients with hepatocellular carcinoma. We therefore developed a predictive model for microvascular invasion of hepatocellular carcinoma to help guide treatment strategies in patients scheduled for either hepatic resection or liver transplantation. METHODS:Patients with hepatocellular carcinoma who underwent hepatic resection or liver transplantation from 1994 to 2016 were divided into training and validation cohorts. A predictive model for microvascular invasion was developed based on microvascular invasion risk factors in the training cohort and validated in the validation cohort. RESULTS:A total of 910 patients (425 having received hepatic resection, 485 having received liver transplantation) were included in the training (n = 637) and validation (n = 273) cohorts. Multivariate analysis identified α-fetoprotein ≥100 ng/mL (relative risk 3.05, P < .0001), tumor size ≥40 mm (relative risk 1.98, P = .0002), nonboundary hepatocellular carcinoma type (relative risk 1.91, P = .001), neutrophil-to-lymphocyte ratio (relative risk 1.86, P = .002), and aspartate aminotransferase (relative risk 1.53, P = .02) as associated with microvascular invasion. The estimated probability of microvascular invasion ranged from 17.0% in patients with none of these factors to 86.9% in the presence of all factors. This model achieved a C-index of 0.732 in the validation cohort. The 5-year overall survival of patients with ≥50% probability of microvascular invasion was poorer than that of patients with <50% probability (hepatic resection; 39.1% vs 61.2%, P < .0001, liver transplantation; 5-year overall survival, 54.8% vs 79.0%, P = .05). CONCLUSION:This model developed from preoperative data allows reliable prediction of microvascular invasion in candidates for either hepatic resection or liver transplantation.

journal_name

Surgery

journal_title

Surgery

authors

Nitta H,Allard MA,Sebagh M,Karam V,Ciacio O,Pittau G,Vibert E,Sa Cunha A,Cherqui D,Castaing D,Bismuth H,Guettier C,Samuel D,Baba H,Adam R

doi

10.1016/j.surg.2019.01.012

subject

Has Abstract

pub_date

2019-06-01 00:00:00

pages

1168-1175

issue

eissn

0039-6060

issn

1532-7361

pii

S0039-6060(19)30043-1

journal_volume

165

pub_type

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Predictive model for microvascular invasion of hepatocellular carcinoma among candidates for either hepatic resection or liver transplantation.