Zhongguo quanke yixue (Apr 2022)
Predictive Value of C-reactive Protein to Albumin Ratio for Microvascular Invasion in Single Small Hepatocellular Carcinoma
Abstract
Background The microvascular invasion pathologically diagnosed in hepatocellular carcinoma (HCC) has not been valued enough in previous studies. And there are no unified pathological diagnostic criteria for microvascular invasion in HCC. Besides that, microvascular invasion is not included as a routine pathological indicator for HCC. C-reactive protein to albumin ratio (CAR) is a new systemic inflammatory factor that is closely related to the proliferation, invasion, metastasis and other malignant biological behaviors of HCC. Objective To investigate the value of CAR in predicting microvascular invasion in single small HCC. Methods Participants (n=346) who were pathologically diagnosed with HCC following the resection of single liver tumor (diameter≤5 cm) were selected from the First Affiliated Hospital of Xinjiang Medical University from June 2017 to June 2021. Demographic data and calculated CAR were collected. ROC analysis was performed to estimate the predictive value and optimal cut-off value of CAR for microvascular invasion in single small HCC. All patients were divided into two groups according to the optimal cut-off value of CAR (≥0.03 or <0.03) , and those with similar propensity scores estimated by Logistic model were matched by 1∶1 nearest neighbor matching, yielding two comparison groups with highly similar clinical characteristics, and the microvascular invasion rate between them was compared. Logistic regression was used in the sensitivity analysis of the predictive value of CAR for microvascular invasion in single small HCC before and after the aforementioned matching. Results One hundred and thirty-one (37.9%) cases were found with microvascular invasion and other 125 without (62.1%) . ROC analysis revealed that the AUC of CAR in predicting microvascular invasion in single small HCC was 0.787〔95%CI (0.697, 0.877) 〕, with 82.9% sensitivity and specificity 76.4% when the optimal cut-off point was determined as 0.03. Ninety-two of 145 cases with CAR<0.03 and 92 of 201 cases with CAR≥0.03 were successful matched, and the prevalence of microvascular invasion was found to be lower in the former group〔13.0% (12/92) vs 43.5% (40/92) 〕 (χ2=6.314, P=0.013) . Three Logistic models showed that CAR was an independent predictor of microvascular invasion in single small HCC, regardless of whether the participants were matched or not (P<0.05) . Conclusion CAR could be used as a predictor for microvascular invasion in single small HCC. CAR≥0.03 may indicate a very high probability of microvascular invasion.
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