<p>Novel Prognostic Nomograms for Predicting Early and Late Recurrence of Hepatocellular Carcinoma After Curative Hepatectomy</p>

Abstract

Aim: Hepatectomy is the main curative method for patients with hepatocellular carcinoma (HCC) in China. Unfortunately, high recurrence rate after hepatectomy poses negative impact on the prognosis of patients. This study aimed to develop prognostic nomograms to predict early recurrence (ER) and late recurrence (LR) of HCC after curative hepatectomy. Patients and Methods: Total of 318 HCC patients undergoing curative hepatectomy from January 2012 to January 2018 were retrospectively recruited. Potential risk factors that were significant for predicting ER and LR in univariate analysis were selected for multivariate survival model analysis using the backward stepwise method. Risk factors identified in multivariate analysis were used to develop nomograms to predict ER and LR. The nomogram was internally validated using 2,000 bootstrap samples from 75% of the original data. Results: Among 318 patients, 164 showed postoperative recurrence, of which 140 and 24 had ER (≤2 years) and LR (>2 years), respectively. Multivariate analysis showed that age, Hong Kong Liver Cancer Stage, albumin-bilirubin, METAVIR fibrosis grade, and microvascular invasion were risk factors of ER for HCC after curative hepatectomy. The AUC of the ROC curve for ER in the development set (D-set) was 0.888 while that in the validation set (V-set) was 0.812. Neutrophil/lymphocyte ratio and glypican-3 (+) were risk factors for LR in HCC patients after curative hepatectomy. The AUC of the ROC curve for LR predictive nomogram that integrated all independent predictors was 0.831. The AUC of the ROC curve for LR in the D-set was 0.833, while that for LR in the V-set was 0.733. The C-index and AUC of ROC for the proposed nomograms were more satisfactory than three conventional HCC staging systems used in this study. Conclusion: We developed novel nomograms to predict ER and LR of HCC patients after curative hepatectomy for clinical use to individualize follow-up and therapeutic strategies.

Development of a computed tomography-based radiomics nomogram for prediction of transarterial chemoembolization refractoriness in hepatocellular carcinoma

“…Irregular tumour margin was confirmed as a reliable predictor of microvascular invasion (MVI)[ 30 ]. MVI has been regarded as an important risk factor affecting the prognosis of HCC patients after treatment[ 31 ]. In our study, irregular tumour margin had a significant effect on patient survival, indicating that it also had an increasing trend in the development of TACE refractoriness.…”

Establishment and Evaluation of a Predictive Model for Early Postoperative Recurrence of Hepatocellular Carcinoma in Patients with Microvascular Invasion

“…The early/late recurrence groups are then determined according to the defined recurrence time point, and the two groups are compared to find the risk factors for early recurrence. 15 , 23 We consider that those methods have the following shortcomings. 1) The difference between the two groups may represent only the difference in the composition of the variables between patients with early/late recurrence, and although the study population is limited to the recurrence group, the results of the analysis may not necessarily indicate risk factors for recurrence.…”

“…and BCLC staging. Many previous studies have been conducted to analyze the risk factors for the early recurrence of HCC after hepatectomy/ablation based on imaging 13 or clinical-pathological factors, 14 , 15 and corresponding predictive models have been developed. In patients with HCC undergoing hepatectomy, those in whom HCC is combined with MVI are more likely to experience early recurrence than those without MVI.…”

“…Many studies have been conducted based on imaging 13 or clinical-pathological factors 14 , 15 to develop predictive models for the early recurrence of HCC after surgery or ablation. However, there is no report based on the MVI subgroup to develop a predictive model for early postoperative recurrence; the present study aims to fill this gap.…”

Nomograms based on clinicopathological factors and inflammatory indicators for prediction of early and late recurrence of hepatocellular carcinoma after surgical resection for patients with chronic hepatitis B

“…The difference in patient inclusion criteria (patients with and without hepatitis B) and the cut-off time point (1 year) for early and late HCC recurrence might have resulted in the diverse outcomes. Recently, Xu et al (28) also investigated the risk factors of early and late recurrence of HCC. They adopted a 2-year cut-off time point to classify early and late recurrence of HCC, and found that ALBI was an independent risk factor for early recurrence whereas NLR correlated to late recurrence of HCC, which was different from our outcomes.…”