Abstract
PURPOSE: We aimed to develop and to validate a novel nomogram based on inflammatory markers to preoperatively predict microvascular invasion (MVI) in patients with solitary primary hepatocellular carcinoma (HCC). PATIENTS AND METHODS: Data from 658 patients with solitary primary HCC who underwent hepatectomy at the First Affiliated Hospital of Zhengzhou University from June 2018 to October 2021 were retrospectively analyzed. Patients were divided into training (n=441) and validation (n=217) cohorts according to surgical data. Independent risk factors for MVI were identified via univariate and multivariate logistic regression analyses in the training cohort. A novel nomogram was developed based on the independent risk factors identified. Its accuracy was evaluated using a calibration curve and concordance index (C-index). The predictive value was evaluated using the receiver operating characteristic (ROC) curve and decision curve analysis (DCA). RESULTS: Preoperative alpha-fetoprotein >969 µg/L (P<0.001), tumor size (P=0.002), neutrophil >1.8×10(9)/L (P=0.002), gamma-glutamyl transpeptidase-to-platelet ratio (GPR) >0.32 (P=0.001), aspartate aminotransferase-to-platelet ratio (APR) >0.18 (P<0.001), gamma-glutamyl transpeptidase-to-albumin ratio (GAR) >2.30 (P=0.001), and gamma-glutamyl transpeptidase-to-lymphocyte ratio >29.58 (P<0.001) were identified as preoperative independent risk factors for MVI and were used to establish the nomogram. The C-index of the training and validation cohorts were 0.788 (95% confidence interval [CI]: 0.744-0.831) and 0.735 (95% CI: 0.668-0.802), respectively. The calibration curve analysis revealed that the standard curve fit well with the predicted curve. ROC curve analysis demonstrated high efficiency of the nomogram. DCA verified that the nomogram had notable clinical value. CONCLUSION: Preoperative GPR >0.32, APR >0.18, and GAR >2.30 were independent risk factors for MVI in patients with solitary primary HCC, suggesting their utility as preoperative predictors of MVI. The novel nomogram developed and validated in this study may aid in determining optimal therapeutic approaches for patients with solitary HCC at risk for MVI.