Prognostic Nomogram for Hepatitis B Virus–related Hepatocellular Carcinoma With Adjuvant Transarterial Chemoembolization After Radical Resection

Abstract

Objectives: The objective of this study was to establish a reliable and effective nomogram for predicting prognosis of hepatitis B virus (HBV)–related hepatocellular carcinoma (HCC) with postoperative adjuvant transarterial chemoembolization (TACE). Patients and Methods: A derivation cohort of 370 HCC patients treated with postoperative TACE in the Eastern Hepatobiliary Surgery Hospital from January 2009 to December 2012 were retrospectively analyzed. Univariate and multivariate analysis were performed by Cox regression and independent prognostic factors for overall survival were determined to construct the nomogram. Concordance index (C-index), calibration curve and decision curve analysis were performed to evaluate the capability of the nomogram and the established nomogram was compared with TNM stage and Barcelona Clinic Liver Cancer (BCLC) stage to identify the superior model. The results were validated in a validation cohort of 123 HCC patients in the same center. Results: Multivariate analysis indicated that γ-glutamyl transferase, α-fetoprotein, tumor number, tumor size, satellite lesions, microvascular invasion, and HBV-DNA were independent prognostic factors for overall survival in the derivation cohort, and all these factors were selected into the nomogram. The C-index was 0.755 for survival prediction of the nomogram, which was significantly higher than the TNM stage (0.636, P<0.001) and BCLC stage (0.594, P<0.001). A fair uniformity and a superior net benefit with wide range threshold probabilities were showed in the calibration curves and decision curve analysis. In the validation cohort, the C-index of the nomogram (0.785) also had a higher predictive accuracy than TNM stage (0.744, P=0.019) and BCLC stage (0.616, P<0.001). Conclusions: The nomogram with accurate and reasonable performance was proposed for predicting survival of HBV-related HCC with postoperative adjuvant TACE.

Adjuvant Transarterial Chemoembolization Following Curative-Intent Hepatectomy Versus Hepatectomy Alone for Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…Appropriately selecting patients that will most likely benefit from TACE is therefore imperative in order to optimize outcomes without exposing patients to unnecessary therapeutic interventions. A variety of prognostic tools have been developed over the years for this purpose, utilizing clinical variables (e.g., tumor number and size) [62,63], laboratory values (e.g., AFP, γ-glutamyl transferase levels) [64,65], molecular biomarkers (e.g., Ki67, microRNA-1268a, cochlin) [66][67][68], immunologic parameters (e.g., CD8+ cell infiltration and programmed death-ligand 1 expression) [69], and circulating tumor cells [70]. However, the external validation and comparison of these tools in a prospective setting remains an unmet need.…”

Advances in postoperative adjuvant therapy for primary liver cancer

“…In addition, a meta-analysis and systematic review of randomized studies of the adjuvant TACE therapy suggested that patients with low-risk recurrent HCC do not seem to benefit from the adjuvant therapy[ 33 ]. However, patients with high-risk recurrence of HCC (including tumor diameter > 5 cm, combined vascular invasion, multiple tumors or satellite lesions, and the presence of residual lesions) undergo hepatic resection followed by hepatic artery intervention as adjuvant therapy based on standardized antiviral and hepatoprotective therapy, which may reduce the postoperative recurrence rate and improve DFS/RFS and OS[ 34 , 35 ]. Huang et al [ 36 ] developed a scoring system based on data from 1150 patients with HCC who underwent hepatectomy between 2002 and 2008 to test the efficacy of the TACE adjuvant therapy.…”

Postoperative adjuvant TACE-associated nomogram for predicting the prognosis of resectable Hepatocellular Carcinoma with portal vein Tumor Thrombus after Liver Resection

“…Patients who had experienced no recurrence one month after resection and whose liver function had returned to normal underwent postoperative adjuvant TACE. The recurrence criteria are detailed in our previous study [18]. Using the Seldinger method, adjuvant TACE was conducted for the entire remnant liver of these postoperative patients, via the proper location of the femoral artery, under the guidance of hepatic and CT angiography.…”

“…Tumor differentiation was evaluated and determined according to the Edmondson-Steiner classification [21]. The definitions of microvascular invasion (MVI) and satellite lesions were as detailed in our previous studies [18,22].…”