A practical nomogram from the SEER database to predict the prognosis of hepatocellular carcinoma in patients with lymph node metastasis

Abstract

Background: The presence of lymph node (LN) metastases is associated with poor survival outcomes in hepatocellular carcinoma (HCC) patients. Because of the low probability of LN metastasis, research into the prognoses of these patients is difficult. The present study developed a nomogram model to predict the prognosis of HCC patients with LN metastasis. Methods: This retrospective, noninterventional study enrolled patients from the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2015. The following inclusion criteria were used: (I) site recode ICD-O-3 (International Classification of Diseases for Oncology, Third Edition) of 8170-8175 and malignant histological behavior; (II) seventh edition American Joint Committee on Cancer (AJCC) stage N1; (III) older than 18 years; and (IV) available information. Potential prognostic factors were collected from the SEER database; the primary outcomes of interest were overall survival (OS) and disease status. Cox and Lasso regression were used to investigate independent prognostic factors for survival. A prognostic nomogram using these independent risk factors was constructed. The concordance index (C-index) and calibration curves were used to evaluate the model's predictive performance. The clinical benefit was assessed via decision curve analysis (DCA). Results: Patients were randomized into a training group (944 patients) and a validation group (402 patients) in a 70:30 ratio. Grade, T stage, liver surgery, chemotherapy, radiation recode, alpha-fetoprotein level, fibrosis score, tumor size group, and M stage were selected as independent prognostic factors, and a nomogram was developed using these variables. The C-indices of the training and validation groups were 0.70 and 0.73, respectively. Calibration curves for the probability of survival showed good agreement. DCA indicated that the nomogram had positive net benefits. Conclusions: The constructed nomogram may assist clinicians in predicting the prognosis of HCC patients with LN metastasis and may provide a rationale for treatment options.

Development and Validation of a Novel Model to Predict Regional Lymph Node Metastasis in Patients With Hepatocellular Carcinoma

“…Different from intrahepatic cholangiocarcinoma and combined hepatocellular-cholangiocarcinoma (CHC), LNM represents a rare but equally aggressive biological behavior of HCC, secondary only to the lung as the destination that most commonly develops extrahepatic metastasis (9,29,30). The incidence of LNM varies in different clinical observational studies, from 1.2% to 15.3% (10)(11)(12)(13)(14)(15)(16)(17). Some possible confounding factors that could explain such a 10-fold variety were shown as follows: First, several researchers enrolled patients with fibrolamellar carcinoma even CHC, leading to an inappropriate increase in the overall LNM incidence.…”

“…Overall, routine LND in HCC patients is not widely accepted by hepatobiliary surgeons in current clinical practice. Some previous studies advocated routine LND for benefits in outcome improvement, complication prevention, and comprehensive evaluation, but some others hold the opposite opinions (10,11,(23)(24)(25). Wu et al conducted a prospective randomized controlled clinical trial and concluded that LND was safe but could not improve HCC patients' prognoses.…”

“…Compared with hematogenous metastasis, lymph node metastasis (LNM) is a rare but equally vital prognostic factor. The reported incidence of LNM varies, from 1.2% to 15.3% in clinical practice and up to 30.3% in autopsy (10)(11)(12)(13)(14)(15)(16)(17)(18). Because of the dismal prognoses, patients with LNM would be considered to have a systemic disease and classified into advanced stages, including stage IVa in the American Joint Committee on Cancer (AJCC) staging system, stage IIIb in the China Liver Cancer (CNLC) staging system and stage C in the Barcelona Clinic Liver Cancer (BCLC) staging system (6,19).…”

“…Several researchers have supported routine LND for outcome improvement, complication prevention, and comprehensive evaluation (20)(21)(22). Some other studies demonstrated no benefit of LND because of the similar survival, low incidence of LNM, and potentially increased postoperative morbidity (10,11,(23)(24)(25). Another concern is how to accurately evaluate nodal status before surgery, which is important for decision-making of surgical strategies.…”

A New Clinical Nomogram From the TCGA Database to Predict the Prognosis of Hepatocellular Carcinoma

“…Due to the heterogeneity of hepatocellular carcinoma, it is difficult to evaluate the patient prognosis. In recent years, a variety of methods have been used to evaluate the prognosis, among which the nomogram has been widely used in clinical evaluation and improves prognosis assessment (7,8). The nomogram is a graphical description of the predictive statistical model for a single patient (9).…”