Nomograms to Predict the Disease-free Survival and Overall Survival after Radiofrequency Ablation for Hepatocellular Carcinoma

Abstract

Objective The purpose of this study was to construct nomograms for the disease-free survival (DFS) and overall survival (OS) of post-radiofrequency ablation (RFA) patients with hepatocellular carcinoma (HCC). Furthermore, we compared the prognostic predictive ability of these nomograms for estimating per-patient outcomes with that of traditional staging systems. Methods We retrospectively enrolled 298 patients in the training set and 272 patients in the validation set who underwent RFA for HCC. The nomograms for the DFS and OS were constructed from the training set using the multivariate Cox proportional hazards model. The discriminatory accuracy of the models was compared with traditional staging systems by analyzing the Harrell's C-index. Results The DFS nomogram was developed based on the tumor size, tumor number, aspartate aminotransferase (AST), albumin, age, and α-fetoprotein. The OS nomogram was developed based on the tumor size, the model for end-stage liver disease, AST, and albumin. Our DFS and OS nomograms had good calibration and discriminatory abilities in the training set, with C-indexes of 0.640 and 0.692, respectively, that were greater than those of traditional staging systems. The C-indexes of our DFS and OS nomograms were also greater than those of traditional staging systems in the validation set, with C-indexes of 0.614 and 0.657, respectively. RFA patients were stratified into low- and high-risk groups based on the median nomogram scores. High-risk patients receiving surgical resection (SR) were associated with a better DFS and OS than those undergoing RFA. However, the DFS and OS were similar between the low-risk RFA and SR groups. Conclusion We constructed reliable and useful nomograms that accurately predict the DFS and OS after RFA for early-stage HCC patients. These graphical tools are easy to use and will assist physicians during the therapeutic decision-making process.

Development and validation of a prognostic model for patients with hepatocellular carcinoma undergoing radiofrequency ablation

“…In the current study, based on the previous experience that large variations exist in clinical outcomes among patients with HCC undergoing RFA as first‐line treatment, we aimed to develop and validate a novel prognostic nomogram optimized for such patients through large patient cohorts. As a matter of fact, current staging or scoring systems have hardly discriminated the individual patient's prognosis because they did not fully appreciate the heterogeneity of HCC patients treated with RFA . By a novel nomogram using the tumor characteristics, hepatic functional reserve, and host's immunological factor, accurate stratification of HCC patients treated with RFA into distinct prognostic subgroups might be available, providing a better discriminatory ability compared to other staging or scoring systems.…”

“…So, we tried to recruit an independent cohort during the same study period to support the clinical relevance of our proposed nomogram. In addition, the large sample size of more than 700 patients in the derivation cohort may have further improved the statistical power, compared to the previous study . Second, the easy‐to‐use graphical tool consists of variables routinely evaluated in clinics such as tumor size, tumor number, AFP level, PIVKA‐II level, lymphocyte count, albumin level, and presence of ascites.…”

“…As a matter of fact, current staging or scoring systems have hardly discriminated the individual patient's prognosis because they did not fully appreciate the heterogeneity of HCC patients treated with RFA. 22 By a novel nomogram using the tumor characteristics, hepatic functional reserve, and host's immunological factor, accurate stratification of HCC patients treated with RFA into distinct prognostic subgroups might be available, providing a better discriminatory ability compared to other staging or scoring systems. Our study has several strengths.…”

An excellent nomogram predicts microvascular invasion that cannot independently stratify outcomes of small hepatocellular carcinoma

“…The 5-year overall survival (OS) of HCC is approximately 10-20% (2-4), with 5-year recurrence rate after liver resection reaching 50-70% (5). Increasing evidence shows that microvascular invasion (MVI) impairs the surgical outcome (6,7), and tumor size is closely correlated to the incidence of MVI (7) and poor prognosis (8). This implies tumor size may be a potential confounder-a major threat to the retrospective study's validity-for MVI in predicting prognosis.…”

Expression of Spindle and Kinetochore-related Complex Subunit 3 is Associate With the Progression and Prognosis of Hepatocellular Carcinoma and Pancreatic Adenocarcinoma

“…As such, it claims numerous lives worldwide each year [10]. Despite the development of innovative therapies, such as liver transplantation, liver resection, immunotherapy, and chemotherapy [11], the prognosis of HCC is often poor due to its high recurrence and metastasis rates [12,13]. Many biomarkers have been identi ed to predict the prognosis and guide HCC treatment.…”