Background/Objectives:MVI is a relevant prognostic factor among patients with hepatocellular carcinoma (HCC) receiving liver transplantation (LT). The preoperative assessment of the risk for MVI is relevant to pre-LT patient management and selection. The objective of this study was to create and validate a model to predict microvascular invasion (MVI) based on preoperative variables in the LT setting.Methods: A total of 2170 patients from 11 collaborative centers in Europe, Asia, and the US, who received transplants between 1 January 2000 and 31 December 2017, were enrolled in the study. The entire cohort was split into a training and a validation set (70/30% of the initial cohort, respectively) using random selection.Results: MVI was reported in 586 (27.0%) explanted specimens. Using the training set data, multivariable logistic regression identified three preoperative parameters associated with MVI: α-fetoprotein (lnAFP; odds ratio [OR] = 1.19; 95% confidence interval [CI] = 1.13–1.27), imaging tumor burden score (lnTBS; OR = 1.66; 95%CI = 1.39–1.99), and a fast-track approach before LT due to the availability of a live donation (OR = 1.99; 95%CI = 1.56–2.53). In the validation set, the LT-MVI c-index was 0.74, versus 0.69 for the MVI score proposed by Endo et al. (Brier Skill Score +75%). The new score had a relevant net reclassification index (overall value = 0.61). Stratifying the validation set into three risk categories (0–50th, 51st–75th, and >75th score percentiles), a very good stratification was observed in terms of disease-free (5-year: 89.3, 75.5, and 50.7%, respectively) and overall survival (5-year: 79.5, 72.6, and 53.7%, respectively).Conclusions: The preoperative assessment of MVI using the proposed score demonstrated very good accuracy in predicting MVI after LT.
背景/目的：微血管侵犯（MVI）是肝细胞癌（HCC）患者接受肝移植（LT）后的重要预后因素。术前评估MVI风险对于肝移植前的患者管理和选择具有重要意义。本研究旨在建立并验证一个基于肝移植术前变量的MVI预测模型。 方法：本研究纳入了来自欧洲、亚洲和美国11个合作中心的2170例患者，这些患者在2000年1月1日至2017年12月31日期间接受了肝移植。通过随机选择，将整个队列分为训练集和验证集（分别占初始队列的70%和30%）。 结果：在586例（27.0%）移植肝标本中报告了MVI。利用训练集数据，多变量逻辑回归分析确定了三个与MVI相关的术前参数：甲胎蛋白（lnAFP；比值比[OR] = 1.19；95%置信区间[CI] = 1.13–1.27）、影像学肿瘤负荷评分（lnTBS；OR = 1.66；95%CI = 1.39–1.99）以及因活体捐献可用性而在肝移植前采用的快速通道方法（OR = 1.99；95%CI = 1.56–2.53）。在验证集中，LT-MVI模型的c指数为0.74，而Endo等人提出的MVI评分的c指数为0.69（Brier技能评分+75%）。新评分具有显著的重分类改善指数（总体值=0.61）。将验证集分为三个风险类别（0–50百分位、51–75百分位和>75百分位），在无病生存率（5年：分别为89.3%、75.5%和50.7%）和总生存率（5年：分别为79.5%、72.6%和53.7%）方面观察到非常好的分层效果。 结论：使用所提出的评分进行术前MVI评估，在预测肝移植后MVI方面表现出非常好的准确性。
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