Nomogram For Preoperative Estimation Of Microvascular Invasion Risk In Recurrent Hepatocellular Carcinoma

Objective:To investigate the risk factors of microvascular invasion(MVI)in patients with recurrent hepatocellular carcinoma(HCC)and construct a nomogram prediction model.Methods: This study was a retrospective case-control study that collected and reviewed the clinicopathological data of 95 recurrent hepatocellular carcinoma patients who underwent surgery from January 2012 to December 2017 in the Department of hepatobiliary Surgery of Fujian Provincial Hospital.Inclusion criteria :(1)age≥18 years old;(2)radical resection was performed for the first liver cancer.The recurrence had the characteristic of typical liver cancer imaging;(3)the focus conduct radical surgical resection evaluation by CT、MRI、PET and other imaging;(4)Chlid-Pugh A/B grade;(5)Patients without other organ dysfunction,toletrant surgery.Exclusion criteria :(1)death with 30 days after surgery;(2)macroscopic vein tumor thrombus;(3)palliative resection;(4)Patients with gastir cancer,pancreatic cancer or other tumors;(5)clinical date follow-up date are not complete.The relationship between age,sex,preoperative ALT,tumor size,number,differentiation,recurrence type(early/late),,preoperative antiviral therapy and microvascular invasion of recurrent liver cancer(MVI-2nd)was analyzed by univariate analysis.Then,incorporated predictors of MVI,which were screened by multivariate logistic regression,were plotted by the "rms" package in R software to establish a nomogram model.According to the scale of the nomogram of each risk factor,the total score could be obtained by adding each single score,then the corresponding probability of the MVI-2nd could be acqured.Rusults: The first MVI positive rate was 30.5%(29/95)and the second MVI positive rate was 41.1%(39/95).Univariate analysis showed that these factors from primary liver cancer(including differentiation degree,TNM stage,and microvascular invasion MVI-1st),preoperative AFP,preoperative HBV-DNA,and types of recurrence were associated with the occurrence of MVI-2nd(P<0.05).The low differentiation degree of first hepatectomy was(0R=0.285,95%CI:0.089-0.913,P=0.035),MVI-1st was(0R=0.205,95%CI:0.066-0.636,P=0.006),the preoperative AFP >20 ng/ml was(0R=0.341,95%CI:0.117-0.992,P=0.048),thepreoperative HBV-DNA >2000 IU/ml was(0R=0.208,95%CI:0.053-0.821,P=0.025),and the early recurrence was(0R=0.332,95%CI:0.112-0.985,P=0.047).According to these results,a nomogram prediction model was constructed.The low differentiation degree of first hepatectomy was for 73 points,MVI-1st was 100 points,the preoperative AFP >20 ng/ml was for 70 points,the preo-perative HBV-DNA >2000 IU/ml was for 92 points,and the early recurrence was72 points.Adding all the points of each risk factor,the corresponding probability of total score would indicated MVI predicted by this nomogram modal.The AUC of the nomogram was 0.788(95%CI:0.688-0.887),and the C-index was 0.788 after internal verification.The calibration curve showed that the predictive results were well correlated with the actual results.Conclusion: Low differentiation degree of first hepatectomy,MVI-1st,preoperative AFP >20 ng/ml,preoperative HBV-DNA >2000 IU/ml,early recurrence are independent risk factors for the MVI-2nd.the nomogram is helpful to predict the probability of the MVI-2nd.