Analysis Of Risk Factors For The Formation Of Tumor Thrombus In The Branch Of Portal Vein With Primary Liver Cancer Based On Clinical And MRI Features

Objective This study aimed to investigate the risk factors of the formation of tumor thrombus in the branch of portal vein(type I and type II portal vein tumor thrombus)in patients with primary liver cancer(PLC)by analyzing the clinical data and MRI characteristics,and the value of establishing a risk prediction scoring model based on this.Methods According to the criteria of inclusion and exclusion,210 patients with primary liver cancer who were first diagnosed in the General Hospital of Ningxia Medical University from May 2019 to November 2022 were collected in this study,including 169 males and 41 females,aged from 18 to 83 years,with an average of(57.72±10.65)years,82 patients with tumor thrombus in the branch of portal vein and 128 patients without portal vein tumor thrombus.According to different time periods,the patients were divided into derivation(n=147)and validation cohort(n=63)in a ratio of 7:3.In the derivation cohort,147 patients with PLC were 119 males and 28 females,aged from 29 to 77 years,with an average of(57.13±10.20)years.Among them,62 patients had tumor thrombus in the branch of portal vein(19 patients with type I portal vein tumor thrombus and 43 patients with type II portal vein tumor thrombus),and 85 patients had no portal vein tumor thrombus.In the validation cohort,63 patients with PLC included 50 males and 13 females,aged from 18 to 83 years,with an average of(59.10±11.59)years.Among them,20 patients had tumor thrombus in the branch of portal vein(7 patients with type I portal vein tumor thrombus and 13 patients with type II portal vein tumor thrombus),and 43 patients had no portal vein tumor thrombus.The clinical data and MRI characteristics of patients with PLC in the derivation cohort were analyzed by univariate and multivariate factors,to identify independent risk factors of the formation of tumor thrombus in the branch of portal vein,and thus establish a risk prediction scoring model.Hosmer-Lemeshow test was used to evaluate the fitting effect of the model,and area under the receiver operating characteristic curve(AUC)was used to test the discrimination of the model,and the data of patients with PLC in the validation cohort were used to verify and evaluate the model.Results In this study,the univariate analysis of the clinical data and MRI features of patients with PLC in the derivation cohort showed that alpha-fetoprotein(χ2=17.030,P<0.001),plasma D-dimer(Z=-4.056,P < 0.001),neutrophils(Z=-3.264,P=0.001),neutrophil/lymphocyte ratio(Z=-3.530,P<0.001),maximum tumor diameter(Z=-8.068,P<0.001),tumor location(χ2=14.282,P<0.001),tumor irregular margin(χ2=28.633,P<0.001),tumor capsule(χ2=39.235,P<0.001),peritumoral enhancement(χ2=20.718,P<0.001),intratumoral artery(χ2=19.947,P<0.001)and hepatic artery portal venous fistula(χ2=5.044,P=0.025)were significantly associated with the formation of tumor thrombus in the branch of portal vein(P<0.05).The multivariate logistic regression analysis showed that large maximum diameter of tumor(OR=1.491,95%CI:1.193～1.862,P<0.001),incomplete tumor capsule(OR=9.054,95%CI:1.751～46.807,P=0.009)and peritumoral enhancement(OR=3.509,95%CI:1.153～10.682,P=0.027)were independent risk factors for the formation of tumor thrombus in the branch of portal vein.The area under receiver operating characteristic of the risk prediction scoring model constructed by this method was 0.918(95%CI: 0.875～0.962),and the sensitivity was 91.9%,and the specificity was 83.5% in the derivation cohort.In the validation cohort,the AUC of this model was 0.928(95%CI: 0.860～0.996),and the sensitivity was 90.0%,and the specificity was 90.7%.The cut-off value of the prediction score is-3.507,when a score of >-3.507 defined as high risk of the formation of tumor thrombus in the branch of portal vein,and a score of ≤-3.507 defined as low risk of the formation of tumor thrombus in the branch of portal vein.Conclusion In the MRI features of PLC,the large maximum diameter of tumor,the incomplete tumor capsule and the peritumoral enhancement were independent risk factors for the formation of tumor thrombus in the branch of portal vein.The risk prediction scoring model established based on them has high diagnostic efficiency,certain clinical significance and reference value for the early diagnosis and treatment of tumor thrombus in the branch of portal vein with primary liver cancer and the screening of high-risk groups,which can improve the clinical diagnosis rate of tumor thrombus in the branch of portal vein.