Discussion
tumor
TUMOR, INFILTRATION, TUMOR RECURRENCE, LYMPH NODE METASTASIS
In the present study, a preoperative prediction model of MVI in HBV-related ICC was built and validated based on 626 patients undergoing curative surgical resection. Five independent risk factors, including TBIL, CA19-9, tumor size, tumor number, and preoperative image lymph node metastasis, were identified to constructed the prediction model. The discrimination showed the area under the ROC curve was 0.874 and 0.729 in the training and validation cohort, respectively. The calibration plots also showed a good fit, which means a good agreement between the actual observation and the prediction for the probability of MVI. Moreover, decision curve analysis showed a good net benefit from this preoperative prediction model of MVI. To our knowledge, this is the first preoperative prediction model of MVI for HBV-related ICC.MVI refers to microscopically visible tumor infiltration in the portal vein, hepatic vein, or larger cystic blood vessels surrounding the liver tissue adjacent to the tumor, which is only visible under the microscope. MVI has been recognized as a clear and independent risk factor associated with tumor recurrence and overall survival after ICC curative resection, and is attracting increasing attention from the surgeons, pathologists, and researchers around the world [We also noticed that there are mainly two published studies referring prediction MVI in ICC patients preoperatively [However, there are still some limitations in the present study. First, there is an inherent bias in retrospective studies. Thus, more validation in other centers and randomized controlled trial are still needed. Secondly, the present study only included HBV-related ICC. The prediction model needs to be validated in other patients with ICC. Thirdly, the accuracy of preoperative lymph nodes status based on image remains to be confirmed. We have noticed that several studies have explored this question [