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Journal of Gastrointestinal Surgery
Published in: Journal of Gastrointestinal Surgery 12/2019

01-12-2019 | Hepatocellular Carcinoma | Original Article

Nomogram to Assist in Surgical Plan for Hepatocellular Carcinoma: a Prediction Model for Microvascular Invasion

Authors: Shengtao Lin, Feng Ye, Weiqi Rong, Ying Song, Fan Wu, Yunhe Liu, Yiling Zheng, Tana Siqin, Kai Zhang, Liming Wang, Jianxiong Wu

Published in: Journal of Gastrointestinal Surgery | Issue 12/2019

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Abstract

Background

Microvascular invasion (MVI) relates to poor survival in hepatocellular carcinoma (HCC) patients. In this study, we aim at developing a nomogram for MVI prediction and potential assistance in surgical planning.

Methods

A total of 357 patients were assigned to training (n = 257) and validation (n = 100) cohort. Univariate and multivariate analyses were used to reveal preoperative predictors for MVI. A nomogram incorporating independent predictors was constructed and validated. Disease-free survival was compared between patients, and the potential of the predicted MVI in making surgical procedure was also explored.

Results

Pathological examination confirmed MVI in 140 (39.2%) patients. Imaging features including larger tumor, intra-tumoral artery, tumor type, and higher serum AFP independently correlated with MVI. The nomogram showed desirable performance with an AUROC of 0.803 (95% CI, 0.746–0.860) and 0.814 (95% CI, 0.720–0.908) in the training and validation cohorts, respectively. Good calibration were also revealed by calibration curve in both cohorts. The decision curve analysis indicated that the prediction nomogram was of promising usefulness in clinical work. In addition, survival analysis revealed that patients with positive-predicted MVI suffered a higher risk of early recurrence (P < 0.01). There was no difference in disease-free survival between anatomic or non-anatomic resection in large HCC or small HCC without nomogram-predicted MVI. However, anatomic resection improved disease-free survival in small HCC with nomogram-predicted MVI.

Conclusions

The nomogram obtained desirable results in predicting MVI. Patients with predicted MVI were associated with early recurrence and anatomic resection was recommended for small HCC patients with predicted MVI.
Appendix
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Literature
1.
Bruix J, Reig M, Sherman M. Evidence-Based Diagnosis, Staging, and Treatment of Patients With Hepatocellular Carcinoma. Gastroenterology. 2016; 150: 835–53.CrossRef
2.
Vitale A, Peck-Radosavljevic M, Giannini EG, Vibert E, Sieghart W, Van Poucke S, Pawlik TM. Personalized treatment of patients with very early hepatocellular carcinoma. J Hepatol. 2017; 66: 412–23.CrossRef
3.
Zhang X, Li J, Shen F, Lau WY. Significance of presence of microvascular invasion in specimens obtained after surgical treatment of hepatocellular carcinoma. J Gastroenterol Hepatol. 2018; 33: 347–54.CrossRef
4.
Rodríguez-Perálvarez M, Luong TV, Andreana L, Meyer T, Dhillon AP, Burroughs AK. A Systematic Review of Microvascular Invasion in Hepatocellular Carcinoma: Diagnostic and Prognostic Variability. Ann Surg Oncol. 2012; 20: 325–39.CrossRef
5.
McHugh PP, Gilbert J, Vera S, Koch A, Ranjan D, Gedaly R. Alpha-fetoprotein and tumour size are associated with microvascular invasion in explanted livers of patients undergoing transplantation with hepatocellular carcinoma. HPB (Oxford). U; 12: 56–61.CrossRef
6.
Cucchetti A, Piscaglia F, Grigioni AD, Ravaioli M, Cescon M, Zanello M, Grazi GL, Golfieri R, Grigioni WF, Pinna AD. Preoperative prediction of hepatocellular carcinoma tumour grade and micro-vascular invasion by means of artificial neural network: a pilot study. J Hepatol. 2010; 52: 880–8.CrossRef
7.
Eguchi S, Takatsuki M, Hidaka M, Soyama A, Tomonaga T, Muraoka I, Kanematsu T. Predictor for histological microvascular invasion of hepatocellular carcinoma: a lesson from 229 consecutive cases of curative liver resection. World J Surg. 2010; 34: 1034–8.CrossRef
8.
Pote N, Cauchy F, Albuquerque M, Voitot H, Belghiti J, Castera L, Puy H, Bedossa P, Paradis V. Performance of PIVKA-II for early hepatocellular carcinoma diagnosis and prediction of microvascular invasion. J Hepatol. 2015; 62: 848–54.CrossRef
9.
Gouw AS, Balabaud C, Kusano H, Todo S, Ichida T, Kojiro M. Markers for microvascular invasion in hepatocellular carcinoma: where do we stand? Liver Transpl. 2011; 17 Suppl 2: S72–80.CrossRef
10.
Sterling RK, Wright EC, Morgan TR, Seeff LB, Hoefs JC, Di Bisceglie AM, Dienstag JL, Lok AS. Frequency of elevated hepatocellular carcinoma (HCC) biomarkers in patients with advanced hepatitis C. Am J Gastroenterol. 2012; 107: 64–74.CrossRef
11.
Lee JM, Yoon JH, Joo I, Woo HS. Recent Advances in CT and MR Imaging for Evaluation of Hepatocellular Carcinoma. Liver Cancer. 2012; 1: 22–40.CrossRef
12.
Ahn SY, Lee JM, Joo I, Lee ES, Lee SJ, Cheon GJ, Han JK, Choi BI. Prediction of microvascular invasion of hepatocellular carcinoma using gadoxetic acid-enhanced MR and (18)F-FDG PET/CT. Abdom Imaging. 2015; 40: 843–51.CrossRef
13.
Kim H, Park MS, Choi JY, Park YN, Kim MJ, Kim KS, Choi JS, Han KH, Kim E, Kim KW. Can microvessel invasion of hepatocellular carcinoma be predicted by pre-operative MRI? Eur Radiol. 2009; 19: 1744–51.CrossRef
14.
Ariizumi S, Kitagawa K, Kotera Y, Takahashi Y, Katagiri S, Kuwatsuru R, Yamamoto M. A non-smooth tumor margin in the hepatobiliary phase of gadoxetic acid disodium (Gd-EOB-DTPA)-enhanced magnetic resonance imaging predicts microscopic portal vein invasion, intrahepatic metastasis, and early recurrence after hepatectomy in patients with hepatocellular carcinoma. J Hepatobiliary Pancreat Sci. 2011; 18: 575–85.CrossRef
15.
Xu P, Zeng M, Liu K, Shan Y, Xu C, Lin J. Microvascular invasion in small hepatocellular carcinoma: is it predictable with preoperative diffusion-weighted imaging? J Gastroenterol Hepatol. 2014; 29: 330–6.CrossRef
16.
Suh YJ, Kim MJ, Choi JY, Park MS, Kim KW. Preoperative prediction of the microvascular invasion of hepatocellular carcinoma with diffusion-weighted imaging. Liver Transpl. 2012; 18: 1171–8.CrossRef
17.
Zhao W, Liu W, Liu H, Yi X, Hou J, Pei Y, Liu H, Feng D, Liu L, Li W. Preoperative prediction of microvascular invasion of hepatocellular carcinoma with IVIM diffusion-weighted MR imaging and Gd-EOB-DTPA-enhanced MR imaging. PLoS One. 2018; 13: e0197488.CrossRef
18.
Akamatsu N, Cillo U, Cucchetti A, Donadon M, Pinna AD, Torzilli G, Kokudo N. Surgery and Hepatocellular Carcinoma. Liver Cancer. 2016; 6: 44–50.CrossRef
19.
Shindoh J, Makuuchi M, Matsuyama Y, Mise Y, Arita J, Sakamoto Y, Hasegawa K, Kokudo N. Complete removal of the tumor-bearing portal territory decreases local tumor recurrence and improves disease-specific survival of patients with hepatocellular carcinoma. J Hepatol. 2016; 64: 594–600.CrossRef
20.
Hasegawa K, Kokudo N, Imamura H, Matsuyama Y, Aoki T, Minagawa M, Sano K, Sugawara Y, Takayama T, Makuuchi M. Prognostic Impact of Anatomic Resection for Hepatocellular Carcinoma. Ann Surg. 2005; 242: 252–9.CrossRef
21.
Kang CM, Choi GH, Kim DH, Choi SB, Kim KS, Choi JS, Lee WJ. Revisiting the role of nonanatomic resection of small (< or = 4 cm) and single hepatocellular carcinoma in patients with well-preserved liver function. J Surg Res. 2010; 160: 81–9.CrossRef
22.
Tanaka K, Shimada H, Matsumoto C, Matsuo K, Nagano Y, Endo I, Togo S. Anatomic versus limited nonanatomic resection for solitary hepatocellular carcinoma. Surgery. 2008; 143: 607–15.CrossRef
23.
Hirokawa F, Kubo S, Nagano H, Nakai T, Kaibori M, Hayashi M, Takemura S, Wada H, Nakata Y, Matsui K, Ishizaki M, Uchiyama K. Do patients with small solitary hepatocellular carcinomas without macroscopically vascular invasion require anatomic resection? Propensity score analysis. Surgery. 2015; 157: 27–36.CrossRef
24.
Cucchetti A, Qiao GL, Cescon M, Li J, Xia Y, Ercolani G, Shen F, Pinna AD. Anatomic versus nonanatomic resection in cirrhotic patients with early hepatocellular carcinoma. Surgery. 2014; 155: 512–21.CrossRef
25.
Okusaka T, Okada S, Ueno H, Ikeda M, Shimada K, Yamamoto J, Kosuge T, Yamasaki S, Fukushima N, Sakamoto M. Satellite lesions in patients with small hepatocellular carcinoma with reference to clinicopathologic features. Cancer. 2002; 95: 1931–7.CrossRef
26.
Cong WM, Bu H, Chen J, Dong H, Zhu YY, Feng LH, Chen J, Guideline C. Practice guidelines for the pathological diagnosis of primary liver cancer: 2015 update. World J Gastroenterol. 2016; 22: 9279–87.CrossRef
27.
Min JH, Kim YK, Lim S, Jeong WK, Choi D, Lee WJ. Prediction of microvascular invasion of hepatocellular carcinomas with gadoxetic acid-enhanced MR imaging: Impact of intra-tumoral fat detected on chemical-shift images. Eur J Radiol. 2015; 84: 1036–43.CrossRef
28.
Lee S, Kim SH, Lee JE, Sinn DH, Park CK. Preoperative gadoxetic acid-enhanced MRI for predicting microvascular invasion in patients with single hepatocellular carcinoma. J Hepatol. 2017; 67: 526–34.CrossRef
29.
Wang WT, Yang L, Yang ZX, Hu XX, Ding Y, Yan X, Fu CX, Grimm R, Zeng MS, Rao SX. Assessment of Microvascular Invasion of Hepatocellular Carcinoma with Diffusion Kurtosis Imaging. Radiology. 2018; 286: 571–80.CrossRef
30.
Okamura S, Sumie S, Tonan T, Nakano M, Satani M, Shimose S, Shirono T, Iwamoto H, Aino H, Niizeki T, Tajiri N, Kuromatsu R, Okuda K, Nakashima O, Torimura T. Diffusion-weighted magnetic resonance imaging predicts malignant potential in small hepatocellular carcinoma. Dig Liver Dis. 2016; 48: 945–52.CrossRef
31.
Sakata J, Shirai Y, Wakai T, Kaneko K, Nagahashi M, Hatakeyama K. Preoperative predictors of vascular invasion in hepatocellular carcinoma. Eur J Surg Oncol. 2008; 34: 900–5.CrossRef
32.
Lee J, Lee J, Kim S, Baek J, Yun S, Kim K, Han J, Choi B. Enhancement patterns of hepatocellular carcinomas on multiphasicmultidetector row CT: comparison with pathological differentiation. Br J Radiol. 2012; 85: e573–83.CrossRef
33.
Segal E, Sirlin CB, Ooi C, Adler AS, Gollub J, Chen X, Chan BK, Matcuk GR, Barry CT, Chang HY, Kuo MD. Decoding global gene expression programs in liver cancer by noninvasive imaging. Nat Biotechnol. 2007; 25: 675–80.CrossRef
34.
Oriyama T, Yamanaka N, Fujimoto J, Ichikawa N, Okamoto E. Progression of hepatocellular carcinoma as reflected by nuclear DNA ploidy and cellular differentiation. J Hepatol. 1998; 28: 142–9.CrossRef
35.
Kanai T, Hirohashi S, Upton M, Noguchi M, Kishi K, Makuuchi M, Yamasaki S, Hasegawa H, Takayasu K, Moriyama N. Pathology of small hepatocellular carcinoma. A proposal for a new gross classification. Cancer. 1987; 60: 810–9.CrossRef
36.
Chou CT, Chen RC, Lee CW, Ko CJ, Wu HK, Chen YL. Prediction of microvascular invasion of hepatocellular carcinoma by pre-operative CT imaging. Br J Radiol. 2012; 85: 778–83.CrossRef
37.
Chou CT, Chen RC, Lin WC, Ko CJ, Chen CB, Chen YL. Prediction of microvascular invasion of hepatocellular carcinoma: preoperative CT and histopathologic correlation. AJR Am J Roentgenol. 2014; 203: W253–9.CrossRef
38.
Wang L, Wang W, Yao X, Rong W, Wu F, Chen B, Liu M, Lin S, Liu Y, Wu J. Postoperative adjuvant radiotherapy is associated with improved survival in hepatocellular carcinoma with microvascular invasion. Oncotarget. 2017; 8: 79971–81.PubMedPubMedCentral
39.
Wang Z, Ren Z, Chen Y, Hu J, Yang G, Yu L, Yang X, Huang A, Zhang X, Zhou S, Sun H, Wang Y, Ge N, Xu X, Tang Z, Lau W, Fan J, Wang J, Zhou J. Adjuvant Transarterial Chemoembolization for HBV-Related Hepatocellular Carcinoma After Resection: A Randomized Controlled Study. Clin Cancer Res. 2018; 24: 2074–81.CrossRef
40.
Donat M, Alonso S, Pereira F, Ferrero E, Carrion L, Acin-Gandara D, Moreno E. Impact of Histological Factors of Hepatocellular Carcinoma on the Outcome of Liver Transplantation. Transplant Proc. 2016; 48: 1968–77.CrossRef
Metadata
Title
Nomogram to Assist in Surgical Plan for Hepatocellular Carcinoma: a Prediction Model for Microvascular Invasion
Authors
Shengtao Lin
Feng Ye
Weiqi Rong
Ying Song
Fan Wu
Yunhe Liu
Yiling Zheng
Tana Siqin
Kai Zhang
Liming Wang
Jianxiong Wu
Publication date
01-12-2019
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 12/2019
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-019-04140-0

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