Nomogram For Preoperative Prediction Of Microvascular Invasion Risk In Hepatocellular Carcinoma

Figures & data

Table 1 Characteristics Of Patients Compared On The Basis Of Tumor Microvascular Invasion (MVI)

Variables	All Patients (n=513)	MVI-Positive (n=232)	MVI-Negative (n=281)	P-Value
Demographics and history
Age (years)	52.02±11.51	51.18±11.80	52.71±11.24	0.133
Sex
Man	449	206	243	0.502
Woman	64	26	38
BMI	22.93±3.08	22.67±3.10	23.15±3.06	0.159
Diabetes
Yes	38	12	26	0.091
No	475	220	255
Hypertension
Yes	91	39	52	0.644
No	422	193	229
Etiology
HBV	432	201	231	0.237
HCV	12	3	9
Others	69	28	41
Preoperative blood tests
ICG-R15 (%)	6.79±7.14	7.50±8.78	6.20±5.35	0.141
AFP (ng/mL)
≤155	250	92	158	<0.001
>155	263	140	123
CEA (ng/mL)	2.73±3.77	2.92±5.15	2.57±1.94	0.315
CA199 (ng/mL)	26.47±27.52	26.85±25.99	26.17±28.70	0.809
HBeAg
Yes	321	154	167	0.136
No	181	74	107
ALB (g/L)	40.90±4.55	40.93±4.42	40.88±4.65	0.897
TBIL (μmol/L)	14.49±10.48	15.50±13.04	13.66±7.69	0.048
DBIL (μmol/L)	6.58±6.47	7.24±7.87	6.04±4.98	0.037
ALT (U/L)	43.31±40.05	45.40±48.74	41.58±31.09	0.282
AST (U/L)	50.93±46.01	58.41±56.81	44.75±33.52	0.001
ALP (U/L)	116.89±60.12	118.86±52.92	115.53±65.50	0.792
PT (s)	13.86±5.38	13.64±1.28	14.05±7.18	0.383
PTA (%)	96.92±14.15	96.47±14.27	97.30±14.07	0.509
INR	1.07±0.10	1.07±0.10	1.07±0.10	0.612
Neutrophil (10^9/L)	3.43±2.11	3.56±1.52	3.33±2.49	0.219
Lymphocyte (10^9/L)	1.52±0.99	1.41±0.56	1.63±1.22	0.015
Monocyte (10^9/L)	0.82±1.71	0.75±1.52	0.88±1.86	0.380
Platelet (10^9/L)	158.10±74.27	164.53±69.11	152.79±78.00	0.075
HB (g/L)	142.44±61.34	141.21±19.81	143.47±81.02	0.679
NLR	2.61±1.74	2.94±2.05	2.34±1.37	<0.001
PLR	118.36±69.43	128.89±64.17	109.65±72.45	0.002
LMR	3.36±2.17	3.05±1.43	3.62±2.60	0.003
APRI	1.35±5.56	1.17±1.04	1.50±7.45	0.499
ANRI	18.00±18.54	18.86±18.99	17.29±18.16	0.341
Preoperative imaging
Tumor number
Solitary	442	200	242	1.000
Multiple	71	32	39
Tumor size (cm)	6.29±3.91	7.62±4.21	5.19±3.25	<0.001
Splenomegaly
Yes	76	35	41	0.901
No	437	197	240
Ascites
Yes	17	9	8	0.622
No	496	223	273
Liver cirrhosis
Yes	305	139	166	0.857
No	208	93	115

Notes: Categorical variables are expressed as frequency. Continuous variables are expressed as mean (standard deviation).

Abbreviations: ICG-R15, indocyanine green retention rate at 15 min; AFP, α-fetoprotein level; CEA, carcinoembryonic antigen; CA199, cancer antigen 199; HBeAg, hepatitis be antigen; ALB, albumin; TBIL, total bilirubin; DBIL, direct bilirubin; ALT, alanine transaminase; AST, aspartate transaminase; ALP, alkaline phosphatase; PT, prothrombin time; PTA, prothrombin activity; INR, international normalized ratio; NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; LMR, lymphocyte-to-monocyte ratio; APRI, AST-to-platelet ratio index; ANRI, AST-to-neutrophil ratio index.

Figure 1 Receiver operating characteristic (ROC) curves for AFP in HCC patients according to microvascular invasion (MVI)-positive.

Figure 2 Plot of independent risk factors predicting MVI based on multivariate logistic regression analysis.

Figure 3 Nomogram to predict the risk of MVI preoperatively in HCC.

Figure 4 The accuracy of the nomogram for predicting MVI using ROC curve.

Figure 5 Calibration plot of the nomogram for predicting the risk of MVI.

Figure 6 Decision curve analysis of our nomogram.

Table 2 Accuracy Of The Nomogram For Estimating The Risk Of MVI At Different Cutoff Values

Predicted Probability	Threshold	Sensitivity	Specificity	PPV	NPV
0.20	−1.35	100%	2%	46%	100%
0.30	−0.85	90%	28%	51%	77%
0.40	−0.40	68%	58%	57%	69%
0.50	0	50%	80%	67%	66%
0.60	0.41	32%	89%	70%	61%
0.70	0.85	18%	94%	72%	58%
0.80	1.39	9%	99%	87%	57%

Abbreviations: NPV, negative predictive value; PPV, positive predictive value.

Table 3 Accuracy Of The Nomogram For Estimating The Risk Of MVI At Optimal Threshold Value

Variables	Value
Sensitivity	61.64%
Specificity	71.53%
Positive predictive value	64.13%
Negative predictive value	69.31%
Positive likelihood ratio	2.17
Negative likelihood ratio	0.54
ROC area (95% CI)	0.71 (0.66–0.75)
Optimal threshold	−0.25
Predicted probability	0.44

Abbreviations: ROC, receiver operating characteristic; CI, confidence intervals.