Development and validation of prognostic dynamic nomograms for hepatitis B Virus-related hepatocellular carcinoma with microvascular invasion after curative resection

Shilei Bai; Pinghua Yang; Yanping Wei; Jie Wang; Caixia Lu; Yong Xia; Anfeng Si; Baohua Zhang; Feng Shen; Yexiong Tan; Kui Wang

doi:10.3389/fonc.2023.1166327

Development and validation of prognostic dynamic nomograms for hepatitis B Virus-related hepatocellular carcinoma with microvascular invasion after curative resection

Front Oncol. 2023 Apr 19:13:1166327. doi: 10.3389/fonc.2023.1166327. eCollection 2023.

Authors

Shilei Bai¹, Pinghua Yang², Yanping Wei^{3

4}, Jie Wang¹, Caixia Lu¹, Yong Xia⁵, Anfeng Si⁶, Baohua Zhang², Feng Shen³, Yexiong Tan^{3

4}, Kui Wang¹

Affiliations

¹ Department of Hepatic Surgery II, The Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China.
² Department of Biliary Surgery IV, The Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China.
³ International Cooperation Laboratory on Signal Transduction, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China.
⁴ Laboratory of Signal Transduction, National Center for Liver Cancer, Shanghai, China.
⁵ Department of Hepatic Surgery IV, The Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China.
⁶ Department of Surgical Oncology, Qin Huai Medical District of Jinling Hospital, Nanjing Medical University, Nanjing, China.

Abstract

Background and aim: The prediction models of postoperative survival for hepatitis B virus-related hepatocellular carcinoma (HBV-HCC) with microvascular invasion (MVI) have not been well established. The study objective was the development of nomograms to predict disease recurrence and overall survival (OS) in these patients.

Methods: Data were obtained from 1046 HBV-related MVI-positive HCC patients who had undergone curative resection from January 2014 to December 2017. The study was approved by the Eastern Hepatobiliary Surgery Hospital and Jinling Hospital ethics committee, and patients provided informed consent for the use of their data. Nomograms for recurrence and OS were created by Cox regression model in the training cohort (n=530). The modes were verified in an internal validation cohort (n= 265) and an external validation cohort (n= 251).

Results: The nomograms of recurrence and OS based on preoperative serological indicators (HBV-DNA, neutrophil-lymphocyte ratio, a-fetoprotein), tumor clinicopathologic features (diameter, number), surgical margin and postoperative adjuvant TACE achieved high C-indexes of 0.722 (95% confidence interval [CI], 0.711-0.732) and 0.759 (95% CI, 0.747-0.771) in the training cohort, respectively, which were significantly higher than conventional HCC staging systems (BCLC, CNLC, HKLC).The nomograms were validated in the internal validation cohort (0.747 for recurrence, 0.758 for OS) and external validation cohort(0.719 for recurrence, 0.714 for OS) had well-fitted calibration curves. Our nomograms accurately stratified patients with HBV-HCC with MVI into low-, intermediate- and high-risk groups of postsurgical recurrence and mortality. Prediction models for recurrence-free survival (https://baishileiehbh.shinyapps.io/HBV-MVI-HCC-RFS/) and OS (https://baishileiehbh.shinyapps.io/HBV-MVI-HCC-OS/) were constructed.

Conclusions: The two nomograms showed good predictive performance and accurately distinguished different recurrence and OS by the nomograms scores for HBV-HCC patients with MVI after resection.

Keywords: hepatitis B virus; hepatocellular carcinoma; microvascular invasion; nomogram; prognosis.

Grants and funding

The Clinical Research Plan for SHDC (SHDC2020CR2038B); The Explorer Program of Shanghai Scientific and Technological Committee (21TS1400500). Star Cultivation Project of Science and Technology Innovation Action Plan in Shanghai 2022(Yangfan: 22YF1459000); Youth Cultivation Program of Chinese National Natural Science Foundation(2021GZR002). Fund of Science and Technology Commission of Shanghai Municipality (20JC1419400).