A novel nomogram to predict survival of patients with hepatocellular carcinoma after transarterial chemoembolization: a tool for retreatment decision making

Li, Jie; Liu, Chengjun; Zhu, Guoqing; Yang, Junhui; Zhang, Yunjie; Yu, Zhijie; Xia, Junhui

doi:10.21037/atm-22-6513

Cited by 3 publications

(4 citation statements)

References 41 publications

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“…However, TACE is also applied to patients suffering from unresectable early HCC and those with liver-confined advanced diseases [ 5 – 7 ]. However, due to differences in tumor burden and liver reserve function, patients often have different prognosis [ 5 , 8 – 10 ]. This heterogeneity makes prognosis prediction challenging, therefore making treatment decisions for these patients remains difficult.…”

Section: Discussionmentioning

confidence: 99%

“…However, TACE is used in clinical practice beyond the guideline recommendations, not only for patients suffering from unresectable early HCC but also for those with liver-confined advanced disease [ 5 – 7 ]. Due to differences in tumor burden and liver reserve function among cancer patients, there may be heterogeneity in patients receiving TACE, which may result in variable outcomes [ 5 , 8 – 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Construction of a prognostic model for hepatocellular carcinoma patients receiving transarterial chemoembolization treatment based on the Tumor Burden Score

Lin,

Li,

Kong

et al. 2024

BMC Cancer

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Background Patients with hepatocellular carcinoma (HCC) who undergo transarterial chemoembolization (TACE) may have varied outcomes based on their liver function and tumor burden diversity. This study aims to assess the prognostic significance of the tumor burden score (TBS) in these patients and develop a prognostic model for their overall survival. Methods The study involved a retrospective analysis of 644 newly diagnosed HCC patients undergoing TACE treatment. The individuals were assigned randomly to a training cohort (n = 452) and a validation cohort (n = 192). We utilized a multivariate Cox proportional risk model to identify independent preoperative predictive factors. We then evaluated model performance using the area under the curve (AUC), consistency index (c-index), calibration curve, and decision curve analysis (DCA) methods. Results The multivariate analysis revealed four prognostic factors associated with overall survival: Tumor Burden Score, Tumor Extent, Types of portal vein invasion (PVI), and Child-Pugh score. The total score was calculated based on these factors. The model demonstrated strong discriminative ability with high AUC values and c-index, providing high net clinical benefits for patients. Based on the model’s scoring results, patients were categorized into high, medium, and low-risk groups. These results were validated in the validation cohort. Conclusions The tumor burden score shows promise as a viable alternative prognostic indicator for assessing tumor burden in cases of HCC. The new prognostic model can place patients in one of three groups, which will estimate their individual outcomes. For high-risk patients, it is suggested to consider alternative treatment options or provide the best supportive care, as they may not benefit significantly from TACE treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Construction of a prognostic model for hepatocellular carcinoma patients receiving transarterial chemoembolization treatment based on the Tumor Burden Score

Lin,

Li,

Kong

et al. 2024

BMC Cancer

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“… 12 At present, the prediction based on TACE or HCC has been supported by excellent research. 13 , 14 Also, immune checkpoint inhibitor (ICI) combined with VEGF inhibitor is the first-line treatment for advanced HCC. Meanwhile, lymphocytes can significantly affect the immune microenvironment and tumor development, while AST reflects tumor-induced liver damage.…”

Section: Discussionmentioning

confidence: 99%

Construction and Validation of TACE Therapeutic Efficacy by ALR Score and Nomogram: A Large, Multicenter Study

Li¹,

Guo²,

Su³

et al. 2023

JHC

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Background TACE and TACE with or without targeted immunotherapy are crucial comprehensive therapies for middle and advanced HCC. However, a reasonable and concise score is needed to evaluate TACE and TACE combined with systemic therapy in HCC treatment. Methods The HCC patients were grouped into two groups: training group (n = 778) (treated with TACE) and verification group (n = 333). The predictive value of baseline variables on overall survival was analyzed using COX model, and easy-to-use ALR (AST and Lym-R) scores. The best cut-off value of AST and Lym-R were determined using X-Tile software based on total survival time (OS) and further verified via a restricted three-spline method. Meanwhile, the score was further verified using two independent valid sets: TACE combined with targeted therapy and TACE with targeted combined immunotherapy. Results In multivariate analysis, baseline serum AST>57.1 (p < 0.001) and Lym-R≤21.7 (p < 0.001) were identified as independent prognostic factors. The OS of patients in the TACE pooled cohort with 0, 1, and 2 scores were 28.1 (95% CI 24–33.8) months, 15 (95% CI 12.4–18.6) months, and 7.4 (95% CI 5.7–9.1) months, respectively. The time-varying ROC curve based on ALR showed that the AUC values for predicting 1, -2-and 3-year OS were 0.698, 0.718, and 0.636, respectively. These results are confirmed in two independent valid sets of TACE combined with targeted therapy and TACE with targeted combined immunotherapy. And we established a nomogram after COX regression to predict the 1 -, 2- and 3-year survival time. Conclusion Our study confirmed that ALR score can predict the prognosis of HCC treated with TACE or TACE combined with systemic therapy.

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“… 38 , 39 For example, a recent study constructed a novel nomogram to determine patients who may benefit from TACE treatment, and the authors screened factors such as albumin-bilirubin (ALBI) grade and tumor response to construct the model, the results showed that it exhibited ideal predictive performance. 40 However, several factors could potentially impact the efficacy of TACE and the prognosis of patients; therefore, the purpose of this study was to further explore the predictive ability of preoperative inflammatory indicators for TACE patients, by integrating inflammatory indicators to develop clinical nomogram and validate it in external cohort.…”

Section: Introductionmentioning

confidence: 99%

Development and Validation of Nomograms to Predict the Prognosis of Patients With Unresectable Hepatocellular Carcinoma Receiving Transarterial Chemoembolization

Zhao

Zhan

et al. 2023

Clin Med Insights Oncol

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Background: Recent studies have shown that inflammatory indicators are closely related to the prognosis of patients with hepatocellular carcinoma, and they can serve as powerful indices for predicting recurrence and survival time after treatment. However, the predictive ability of inflammatory indicators has not been systematically studied in patients receiving transarterial chemoembolization (TACE). Therefore, the objective of this research was to determine the predictive value of preoperative inflammatory indicators for unresectable hepatocellular carcinoma treated with TACE. Methods: Our retrospective research involved 381 treatment-naïve patients in 3 institutions, including the First Affiliated Hospital of Soochow University, Nantong First People’s Hospital, and Nantong Tumor Hospital, from January 2007 to December 2020 that received TACE as initial treatment. Relevant data of patients were collected from the electronic medical record database, and the recurrence and survival time of patients after treatment were followed up. Least absolute shrinkage and selection operator (LASSO) algorithm was used to compress and screen the variables. We utilized Cox regression to determine the independent factors associated with patient outcomes and constructed a nomogram based on multivariate results. Finally, the nomogram was verified from discriminability, calibration ability, and practical applicability. Results: Multivariate analysis revealed that the levels of aspartate aminotransferase-to-platelet ratio index (APRI) and lymphocyte count were independent influential indicators for overall survival (OS), whereas the levels of platelet-to-lymphocyte ratio (PLR) was an independent influential index for progression. Nomograms exhibited an excellent concordance index (C-index), in the nomogram of OS, the C-index was 0.753 and 0.755 in training and validation cohort, respectively; and in the nomogram of progression, the C-index was 0.781 and 0.700, respectively. The time-dependent C-index, time-dependent receiver operating characteristic (ROC), and time-dependent area under the curve (AUC) of the nomogram all exhibited ideal discrimination ability. Calibration curves significantly coincided with the standard lines, which indicated that the nomogram had high stability and low degree of over-fitting. Decision curve analysis revealed a wider range of threshold probabilities and could augment net benefits. The Kaplan-Meier curves for risk stratification indicated that the prognosis of patients varied significantly between risk categories ( P < .0001). Conclusions: The developed prognostic nomograms based on preoperative inflammatory indicators revealed high predictive accuracy for survival and recurrence. It can be a valuable clinical instrument for guiding individualized treatment and predicting prognosis.

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A novel nomogram to predict survival of patients with hepatocellular carcinoma after transarterial chemoembolization: a tool for retreatment decision making

Cited by 3 publications

References 41 publications

Construction of a prognostic model for hepatocellular carcinoma patients receiving transarterial chemoembolization treatment based on the Tumor Burden Score

Construction of a prognostic model for hepatocellular carcinoma patients receiving transarterial chemoembolization treatment based on the Tumor Burden Score

Construction and Validation of TACE Therapeutic Efficacy by ALR Score and Nomogram: A Large, Multicenter Study

Development and Validation of Nomograms to Predict the Prognosis of Patients With Unresectable Hepatocellular Carcinoma Receiving Transarterial Chemoembolization

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