Abstract:Objective: To establish a risk model for microvascular invasion (MVI) in patients with hepatocellular carcinoma (HCC) based on radiological characteristics and clinical laboratory data, and to explore the clinical application of preoperative alpha-fetoprotein (AFP) and gamma-glutamyl transferase (GGT) in HCC patients. Methods: Clinical data from 479 patients with surgically resected HCC at the First Affiliated Hospital of Nanjing Medical University were retrospectively collected to investigate the effects of potentially relevant factors on MVI and to assess the benefits of serum AFP and GGT on improving model predictive performance. Univariate and multivariate logistic regression analyses were used to select variables for the final prediction model, and the predictive performance of the model was assessed by area under the ROC curve (AUC), calibration curve, and decision curve analysis (DCA). Predictive performance was compared by sensitivity, specificity and accuracy analyses. Kaplan-Meier curves were applied to assess the probability of patient survival. RESULTS: In a multifactorial analysis, tumor size, borders of the tumor, exophytic growth, AFP and GGT were independent predictors for the development of MVI in HCC patients. AFP (OR=1.001, 95% confidence interval 1.001-1.002, P < 0.001) and GGT (OR=1.002, 95% confidence interval 1.001-1.003, P = 0.033) were used in the model to construct the prediction model. Two models were constructed using with AFP, GGT and without, respectively. In both cohorts, model A with AFP and GGT showed better predictive performance than model B without, with AUCs of 0.902 (0.872-0.932) and 0.876 (0.842-0.909), respectively. Two models showed good discrimination, and the predicted probabilities were in good agreement with the observed probabilities. Analysis of the DCA assessing the net clinical benefit of the models showed that model A was slightly better than model B, both with good clinical application. In the subgroup analysis, AFP and GGT could well predict the prognosis of HCC patients. Conclusion: We developed a predictive model for the development of MVI in patients with HCC, and the study confirmed the clinical predictive value of serum AFP and GGT.