Prediction Study On Microvascular Invasion Grade And Postoperative Recurrence Of Primary Hepatocellular Carcinoma

Part One:Risk factors for predicting the grade of microvascular invasion in primary hepatocellular carcinomaObjective:HCC still had a high recurrence rate of 70%after radical hepatectomy,resulting in a very low recurrence-free survival period.The high risk factor for postoperative recurrence was microvascular invasion.Currently,microvascular invasion(MVI)was a hot spot of Hepatocellular carcinoma(HCC)research.However,the current research was mostly limited to the prediction of MVI positive or negative,and the research on the prediction of MVI grade was relatively lacking.Early prediction of MVI grade before hepatectomy could better predict early recurrence of HCC,which was conducive to the selection of treatment options and the evaluation of prognosis.Therefore,this study aimed to explore the independent risk factors for predicting MVI grade in HCC patients.Methods:Retrospective study was conducted on 117 patients with hepatocellular carcinoma which confirmed by post-operative pathology.Baseline data(gender,age,AFP level,hepatitis or not,liver cirrhosis or not),imaging characteristics(tumor diameter,number,envelop)and pathological grading)were analyzed.All cases were divided into three groups:M0(no MVI),M1(MVI low risk group)and M2(MVI high risk group).The single-factor rank sum analysis was performed by Kruskal-Wallis test and Mann-Whitney test,and multivariate analysis was performed by ordered multi-classification logistic regression.Independent risk factors for MVI grade of HCC were identified by these clinicopathological and imaging parameters.ROC curves were drawed to analyze the efficacy of tumor diameter range in predicting MVI grading.Results:The single-factor rank sum test showed significant differences in tumor capsule and diameter(P<0.001),and in tumor Edmondson grading(P=0.037)in patients with different MVI grade.There was no significant difference among other factors in different MVI grade(P>0.05).Further ordered multi-classification logistic regression analysis showed that tumor capsule,diameter and Edmondson grade were independent predictors for predicting MVI grade(P<0.05).The larger the tumor diameter,the higher the MVI grade;No capsule or incomplete capsule,the higher the MVI grade;The lower the degree of tumor differentiation,the higher the MVI grade.The area under the ROC curve was 0.764,and the tumor diameter predicted MVI grading was moderate accuracy.The best cut-off value of tumor diameter for predicting MVI grade was 3.9cm,Specifically,the diameter>3.9cm was a predictor of MVI grade 2,with a sensitivity of 92%and specificity of 48.9%.Conclusion:Tumor diameter and capsule could be used as useful predictors for preoperative MVI grade of HCC,and had the same predictive efficiency as postoperative Edmondson grading.The optimal threshold of tumor diameter for predicting MVI grade was 3.9cm.Part Two:Imaging and pathological prediction of recurrence after hepatocellular carcinoma resectionObjective:Because there were still many controversies about the risk factors for hepatocellular carcinoma recurrence after surgery,this study aimed to explore the predictive value of preoperative clinical indicators,tumor maximum diameter and Apparent Diffusion Coefficient(ADC)value,and postoperative pathological histochemical indicators for recurrence after hepatocellular carcinoma(HCC)resection,so as to carry out early follow-up and intervention for high-risk patients to reduce the recurrence rate and improve the overall postoperative efficacy of HCC patients.Methods:A retrospective study was conducted on 150 patients with HCC after hepatectomy.The data collected included gender,age,preoperative a-fetoprotein(AFP)level,maximum tumor diameter,average ADC value and minimum ADC value,Microvascular invasion(MVI)grade,Edmondson histopathological grade,and Ki67.Receiver-operating characteristic(ROC)curves were used to determine the optimal threshold of maximum tumor diameter,Ki67,minimum ADC value,and mean ADC value to predict HCC recurrence after HCC surgery.The Kaplan-Meier method was used to draw the survival curve(relapse-free survival),and calculate the median survival time of Relapse-free survival(RFS)time after hepatectomy;The Log-Rank test was used to perform univariate analysis of various clinicopathological indicators to examine the influence of each clinicopathological factor on postoperative recurrence and evaluate the risk factors for postoperative recurrence.And the Cox proportional hazard model was used to perform multivariate analysis to screen out the independent factors affecting postoperative recurrence to predict the survival prognosis after hepatocellular carcinoma resection.P<0.05 was considered statistically significant.Results:The ROC curve of the tumor maximum diameter was drawn.According to the ROC curve analysis,the best cut-off value of the tumor maximum diameter to predict postoperative recurrence was 6.2cm,and its AUC was 0.643,P=0.007,that was,the maximum diameter ≥6.2cm could predict postoperative recurrence of the tumor,with sensitivity of 62.7%and and specificity of 70%;The best cut-off value of Ki67 for predicting postoperative recurrence was 35%,and its AUC was 0.649,P=0.005,that was,Ki67>35%could predict postoperative recurrence of tumor,with sensitivity of 46.4%and specificity of 77.5%;The best cut-off value of the minimum ADC value for predicting postoperative recurrence was 0.818×10-3mm2/s,and the AUC was 0.651,P=0.005,that was,the minimum ADC value<0.818×10-3mm2/s could predict postoperative recurrence of tumor,with sensitivity of 43.6%and specificity of 85%.The best cut-off value of the average ADC value for predicting postoperative recurrence was 1.128×10-3mm2/s,and the AUC was 0.652,P=0.004,that was,the average ADC value<1.128×10-3mm2/s could predict postoperative recurrence of tumor,with sensitivity of 62.7%and specificity of 62.5%.Log-Rank test univariate analysis showed that preoperative AFP,Ki67,MVI grade,histological grade,tumor maximum diameter,minimum and average ADC value were important high-risk factors affecting RFS in HCC patients;Cox proportional hazard model multivariate analysis showed that preoperative AFP,maximum tumor diameter,MVI,and Ki67 were important independent predictors of RFS after hepatocellular carcinoma resection.Conclusion:preoperative AFP,Tumor maximum diameter,MVI,and Ki67 could be used as indicators to predict postoperative recurrence of hepatocellular carcinoma,which is helpful for postoperative management of patients with hepatocellular carcinoma and early follow-up and intervention for high-risk patients.