Abstract：
BACKGROUND: Microvascular invasion (MVI) is a risk factor for postoperative recurrence of hepatocellular carcinoma (HCC), even in early-stage HCC. In small HCC ≤ 3 cm, treatment options include anatomical resection or non-anatomical resection, and MVI has a major effect on treatment decisions. We aimed to identify the predictors of MVI in small HCC ≤ 3 cm.
METHODS: We retrospectively studied 129 patients with very early or early-stage HCC ≤ 3 cm who had undergone 18F-fluorodeoxyglucose positron emission tomography/computed tomography and subsequent hepatic resection from January 2016 to August 2023. These patients were divided into the derivation cohort (n = 86) and validation cohort (n = 43). We examined the risk factors for MVI using logistic regression analysis, and established a predictive scoring system in the derivation cohort. We evaluated the accuracy of our scoring system in the validation cohort.
RESULTS: In the derivation cohort, a Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein (AFP-L3), prothrombin induced by vitamin K deficiency or antagonist-II (PIVKA-II), and metabolic tumor volume (MTV) were independent predictors of MVI. We established the scoring system using these three factors. In the validation test, there were no MVI-positive cases with a score of 0 and 1, and all cases were MVI-positive with a score of 4. Moreover, with a score ≥ 2, the sensitivity, specificity, and accuracy of our scoring system were 100%, 71.4%, and 81.4%, respectively.
CONCLUSIONS: Our scoring system can accurately predict MVI in small HCC ≤ 3 cm, and could contribute to establishing an appropriate treatment strategy.
METHODS: We retrospectively studied 129 patients with very early or early-stage HCC ≤ 3 cm who had undergone 18F-fluorodeoxyglucose positron emission tomography/computed tomography and subsequent hepatic resection from January 2016 to August 2023. These patients were divided into the derivation cohort (n = 86) and validation cohort (n = 43). We examined the risk factors for MVI using logistic regression analysis, and established a predictive scoring system in the derivation cohort. We evaluated the accuracy of our scoring system in the validation cohort.
RESULTS: In the derivation cohort, a Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein (AFP-L3), prothrombin induced by vitamin K deficiency or antagonist-II (PIVKA-II), and metabolic tumor volume (MTV) were independent predictors of MVI. We established the scoring system using these three factors. In the validation test, there were no MVI-positive cases with a score of 0 and 1, and all cases were MVI-positive with a score of 4. Moreover, with a score ≥ 2, the sensitivity, specificity, and accuracy of our scoring system were 100%, 71.4%, and 81.4%, respectively.
CONCLUSIONS: Our scoring system can accurately predict MVI in small HCC ≤ 3 cm, and could contribute to establishing an appropriate treatment strategy.
摘要：
背景：微血管侵犯（MVI）是肝细胞癌（HCC）术后复发的危险因素，即使在早期肝癌。在≤3厘米的小肝癌中，治疗方案包括解剖切除或非解剖切除，MVI对治疗决策有重大影响。我们旨在确定≤3厘米的小肝癌MVI的预测因子。
方法：我们回顾性研究了129例非常早期或早期HCC≤3cm的患者，这些患者在2016年1月至2023年8月期间接受了18F-氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描和随后的肝切除术。这些患者被分为衍生队列(n=86)和验证队列(n=43)。我们使用logistic回归分析了MVI的危险因素，并在派生队列中建立了预测评分系统。我们在验证队列中评估了我们的评分系统的准确性。
结果：在派生队列中，α-甲胎蛋白（AFP-L3）的晶状体凝集素反应部分，维生素K缺乏或拮抗剂-II（PIVKA-II）诱导的凝血酶原，代谢性肿瘤体积（MTV）是MVI的独立预测因子。我们使用这三个因素建立了评分系统。在验证测试中，无MVI阳性病例,评分0分和1分,所有病例均为MVI阳性,评分4分。此外，分数≥2，灵敏度，特异性，我们的评分系统的准确率是100%,71.4%,和81.4%，分别。
结论：我们的评分系统可以准确预测≤3cm的小肝癌的MVI，并有助于制定适当的治疗策略。
方法：我们回顾性研究了129例非常早期或早期HCC≤3cm的患者，这些患者在2016年1月至2023年8月期间接受了18F-氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描和随后的肝切除术。这些患者被分为衍生队列(n=86)和验证队列(n=43)。我们使用logistic回归分析了MVI的危险因素，并在派生队列中建立了预测评分系统。我们在验证队列中评估了我们的评分系统的准确性。
结果：在派生队列中，α-甲胎蛋白（AFP-L3）的晶状体凝集素反应部分，维生素K缺乏或拮抗剂-II（PIVKA-II）诱导的凝血酶原，代谢性肿瘤体积（MTV）是MVI的独立预测因子。我们使用这三个因素建立了评分系统。在验证测试中，无MVI阳性病例,评分0分和1分,所有病例均为MVI阳性,评分4分。此外，分数≥2，灵敏度，特异性，我们的评分系统的准确率是100%,71.4%,和81.4%，分别。
结论：我们的评分系统可以准确预测≤3cm的小肝癌的MVI，并有助于制定适当的治疗策略。
