Nomograms for Predicting Hepatocellular Carcinoma Recurrence and Overall Postoperative Patient Survival

Abstract

BackgroundFew studies have focused on the prognosis of patients with hepatocellular carcinoma (HCC) of Barcelona Clinic Liver Cancer (BCLC) stage 0‒C in terms of early recurrence and 5-years overall survival (OS). We sought to develop nomograms for predicting 5-year OS and early recurrence after curative resection of HCC, based on a clinicopathological‒radiological model. We also investigated whether different treatment methods influenced the OS of patients with early recurrence.MethodsRetrospective data, including clinical pathology, radiology, and follow-up data, were collected for 494 patients with HCC who underwent hepatectomy. Nomograms estimating OS and early recurrence were constructed using multivariate Cox regression analysis, based on the random survival forest (RSF) model. We evaluated the discrimination and calibration abilities of the nomograms using concordance indices (C-index), calibration curves, and Kaplan‒Meier curves. OS curves of different treatments for patients who had recurrence within 2 years after curative surgery were depicted and compared using the Kaplan–Meier method and the log-rank test.ResultsMultivariate Cox regression revealed that BCLC stage, non-smooth margin, maximum tumor diameter, age, aspartate aminotransferase levels, microvascular invasion, and differentiation were prognostic factors for OS and were incorporated into the nomogram with good predictive performance in the training (C-index: 0.787) and testing cohorts (C-index: 0.711). A nomogram for recurrence-free survival was also developed based on four prognostic factors (BCLC stage, non-smooth margin, maximum tumor diameter, and microvascular invasion) with good predictive performance in the training (C-index: 0.717) and testing cohorts (C-index: 0.701). In comparison to the BCLC staging system, the C-index (training cohort: 0.787 vs. 0.678, 0.717 vs. 0.675; external cohort 2: 0.748 vs. 0.624, 0.729 vs. 0.587 respectively, for OS and RFS; external cohort1:0.716 vs. 0.627 for RFS, all p value<0.05), and model calibration curves all showed improved performance. Patients who underwent surgery after tumor recurrence had a higher reOS than those who underwent comprehensive treatments and supportive care.ConclusionsThe nomogram, based on clinical, pathological, and radiological factors, demonstrated good accuracy in estimating OS and recurrence, which can guide follow-up and treatment of individual patients. Reoperation may be the best option for patients with recurrence in good condition.

Machine learning integrations develop an antigen-presenting-cells and T-Cells-Infiltration derived LncRNA signature for improving clinical outcomes in hepatocellular carcinoma

“…Current HCC staging systems (e.g., TNM staging system, JSH staging system, BCLC staging system, etc.) have provided great convenience in the prognostic evaluation and treatment regimen qualification of HCC [ 44 , 45 ]. However, due to the complex mechanisms and geographic variations of HCC, these staging systems also have some limitations in the diagnosis and decision-making process for advanced HCC.…”

Epidemiological Characteristics of Primary Liver Cancer in Mainland China From 2003 to 2020: A Representative Multicenter Study

“…Predictors in our prognosis-prediction nomogram differ a little from the current predictors in HCC. The predictors of reported nomograms for HCC prognosis were mostly extracted after surgical treatment, including MVI and resection margin ( 48 , 49 ). Development of a nomogram to preoperatively estimate postoperative survival is also reported ( 50 ).…”

“…The seropositivity for HBV was more frequent in the east (87.6%) and south (87.7%) than in the north (57.2%) and west (61.6%), which was quite in contrast to the seropositivity for anti-HCV antibody (Table 1). Male PLC patients were 2 years younger than female patients at diagnosis (54 [46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62] vs. 56 [48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63] years, P<0.001). Compared to female PLC patients, males had higher proportions of advanced BCLC stage, liver cirrhosis, abnormal total bilirubin, and direct bilirubin.…”

“…HCC, ICC, and CHC accounted for 94.3%, 3.3%, and 1.5% in the males and 85.7%, 10.5%, and 2.0% in the female PLC patients, respectively. Patients with HCC were 3 years younger than patients with ICC at diagnosis (53 [46-61] vs. 57 [49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64], P<0.001). The rate of seropositivity for HBV was 84.4%, 38.6%, and 77.1% while that for anti-HCV antibody was 3.2%, 1.8%, and 1.5% in patients with HCC, patients with ICC, and those with CHC, respectively.…”

Novel Nomograms Based on Gamma-Glutamyl Transpeptidase-to-Lymphocyte Ratio Predict Prognosis of Hepatocellular Carcinoma Patients After Hepatectomy

“…To avoid potential bias brought by short follow-up period, patients who underwent surgery in a relatively early period (>5 years before the analysis) with complete followup data were included. [19][20][21] Patients eligible for the following criteria were included in this study: (1) >18 years old; (2) with pathologically confirmed diagnosis of HCC; (3) underwent curative hepatectomy; (4) with complete laboratory, pathological and follow-up data. The exclusion criteria included (1) <18 years old; (2) cholangiocarcinoma, metastatic tumor and recurrent HCC; (3) resections with residual tumor; (4) incomplete laboratory, pathological or follow-up data;…”