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

Abstract

BackgroundThe evaluation of the nodal status of hepatocellular carcinoma (HCC) is a classic but controversial topic. This study aimed to investigate the incidence of lymph node metastasis (LNM), explore the role of lymph node dissection (LND), and develop and validate a novel model to predict LNM in patients with HCC, not other specified (NOS).MethodsThe study cohort was taken from the Surveillance, Epidemiology, and End Results database. The annual percent change (APC) was calculated using the Joinpoint regression. Survival analyses adopted the competing risk model. The nomogram was constructed based on the least absolute shrinkage and selection operator (LASSO) logistic regression algorithm and validated by calibration curves. The area under the receiver operating characteristic curve (AUROC) was obtained to compare prognostic performance. Decision curve and clinical impact curve analyses were introduced to examine the clinical value of the models.ResultsA total of 8,829 patients were finally enrolled in this study, and 1,346 (15.2%) patients received LND. The LND rate showed no noticeable fluctuation in the last decade, with an APC of 0.5% (P=0.593). LNM was identified in 56 (4.2%) patients and confirmed an independent prognostic factor of HCC patients (P=0.005). There were 2,497 lymph nodes retrieved, and 93 (3.7%) of them were positive. After propensity score matching, LND indicated no direct oncologic benefit and did not worsen competing risks. Moreover, an increased number of lymph nodes retrieved could not improve prognoses. 1,346 patients with LND were further randomly divided into the training and validation sets with the ratio of 1:1. Race, tumor size, clinical T stage, extrahepatic bile duct invasion, and tumor grade were independent risk factors for LNM. The constructed model was well calibrated and showed good discrimination power and net benefits in clinical practice.ConclusionLNM is an independent prognostic factor in HCC, but routine LND seems to be unnecessary in HCC patients. The constructed model could predict the presence of LNM in HCC patients with good performance, which is meaningful to patient stratification and individual treatment strategies optimization.

Risk factors and predictive nomograms for early death of patients with advanced hepatocellular carcinoma: a large retrospective study based on the SEER database

“…In the present study, regardless of stage IVA or stage IVB patients, age was significantly associated with early death, which is consistent with the results of previous studies [ 28 , 29 ]. From the SEER database data and the existing research, HCC is obviously more likely to occur in males [ 30 ]; however, gender was not a risk factor for early death of advanced HCC patients.…”

Epidemiological and Clinical Characteristics of Five Rare Pathological Subtypes of Hepatocellular Carcinoma

“…In the last decades, thanks to better etiological monitoring and management, especially the progress of viral hepatitis prevention and therapy, the morbidity of HCC has shown a trend of decelerated growth and is even gradually decreasing both in the East and West. Nevertheless, HCC is still a heavy health burden worldwide (1)(2)(3)(4)(5)(6)(7). According to a national survey in the USA, HCC ranks 5th and 7th in estimated new cancer deaths for male and female patients in 2022, respectively (1).…”

Comparison of metastasis and prognosis between early-onset and late-onset hepatocellular carcinoma: A population-based study

“…On the one hand, we observed that early-onset patients were inclined to be unmarried, with larger tumor size and worse histological grade than late-onset patients. Furthermore, it has been demonstrated that unmarried status [ 23 ], large tumor diameter [ 24 ], and poor tumor differentiation [ 25 ] were considered independent risk factors for HCC metastasis, which could partially explain why early-onset HCC was prone to experience DM. On the other hand, the lack of suspicion of HCC in the younger patient population has led to delays in seeking medical attention and diagnosing the condition.…”