Development and validation of a nomogram for assessing survival in patients with hepatocellular carcinoma after hepatectomy

Abstract

Background and aim: Assessing the average survival rate of patients with hepatocellular carcinoma (HCC) after hepatectomy is important for making critical decisions in everyday clinical practice. The present study aims to develop and validate a nomogram for assessing the overall survival probability for such patients. Methods: The putative prognostic indicators for constructing the nomogram were identified using multivariable Cox regression and model selection based on the Akaike information criterion. The nomogram was subjected to internal and external validation. The nomogram endpoints were death within 1, 3, and 5 years. Results: A consecutive sample of 522 HCC patients who underwent potentially curative hepatectomy was retrospectively analyzed. Age, Barcelona clinic liver cancer (BCLC) stage, tumor size, alanine transaminase, alpha fetal protein, and serum prealbumin were included in the final model. The nomogram's discriminative ability was good in the training set (C-index was 0.74 for 1 year, 0.73 for 3 years, 0.70 for 5 years) and was validated using both an internal bootstrap method (C-index was 0.73 for 1 year, 0.72 for 3 years, 0.69 for 5 years) and an external validating set (C-index was 0.72 for 1 year, 0.72 for 3 years, 0.69 for 5 years). The calibration plots for the endpoints showed optimal agreement between the nomogram's assessment and actual observations. Conclusions: The nomogram (an Excel-based tool) can be useful for assessing the probability of survival at 1, 3, and 5 years in patients with HCC after hepatectomy.

Preoperative alpha fetoprotein, total bilirubin, fibrinogen, albumin, and lymphocytes predict postoperative survival in hepatocellular carcinoma

“…What is more, we further evaluated the value of preoperative plasma fibrinogen in subgroups of different concentration, and the results showed that only at high levels can fibrinogen be considered a risk prognostic indicator for the survival of HCC, which indicated the specific application prognostic feature of fibrinogen. Nevertheless, several studies have reported that total bilirubin and albumin have no significance to the prognosis of HCC patients with hepatectomy, 8,17,38 which was contrary to our results. We speculate that the possible reasons are as follows.…”

“…At present, AFP is also a well‐known potential risk factor related to the outcome of HCC patients undergoing hepatectomy 15,16 . Our study suggested that elevated AFP was inversely correlated with the OS, the same result was also observed in other studies 8,9,17,18 . Moreover, in the subgroup analysis of our study, we found that AFP is a risk predictor for HCC patients' survival in different concentration ranges.…”

“…15,16 Our study suggested that elevated AFP was inversely correlated with the OS, the same result was also observed in other studies. 8,9,17,18 Moreover, in the subgroup analysis of our study, we found that AFP is a risk predictor for HCC patients' survival in different concentration ranges. However, although AFP is a widely used laboratory indicator for HCC diagnosis and prognosis in clinical practice, its efficacy remains poor.…”

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

“…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 ). Although previous studies have evaluated the prognostic factors of patients with hepatocellular carcinoma ( 10 ), such as Barcelona clinical hepatocellular carcinoma (BCLC), tumor lymph node metastasis (TNM) and tumor markers ( 11 ), the evaluation is more cumbersome and it cannot calculate the specific survival probability.…”

<p>Development and Validation of a Clinicopathological-Based Nomogram to Predict the Survival Outcome of Patients with Recurrent Hepatocellular Carcinoma After Hepatectomy Who Underwent Microwave Ablation</p>

“…Nomograms are pictorial representations of complex mathematical formulas and are commonly used to determine prognosis in medicine and oncology. [15][16][17] Nomograms can be used to identify an individual's probability of experiencing a clinical event through the integration of a variety of prognostic and determinant variables, resulting in biologically and clinically integrated models for the development of personalized medicine. Nomogram-derived prognosis evaluation has been incorporated into clinical decision making, since it offers several advantages compared with conventional staging, including the rapid calculation on graphical user-friendly interfaces, higher level of accuracy and ease of comprehension.…”