Prognostic nomograms and risk classifications of outcomes in very early-stage hepatocellular carcinoma patients after hepatectomy. (March 2021)

• Record Type: Journal Article
• Authors: Feng, Long-Hai; Sun, Hui-Chuan; Zhu, Xiao-Dong; Liu, Xue-Feng; Zhang, Shi-Zhe; Li, Xiao-Long; Li, Yan; Tang, Zhao-You
• Is Part Of: European journal of surgical oncology. Volume 47:Supplement Part B (2021)
• Page Start: 681
• Page End: 689
• Publication Date: 2021-03
• Subjects: Hepatocellular carcinoma -- Very early-stage -- Risk classification -- Prognosis; HCC hepatocellular carcinoma -- BCLC Barcelona Clinic Liver Cancer -- ALPPS associating liver partition and portal vein ligation -- HBsAg hepatitis B surface antigen -- HBsAb hepatitis B surface antibody -- HBeAg hepatitis B e antigen -- HBeAb hepatitis B e antibody -- HBcAb hepatitis B core antibody -- HCV-Ab hepatitis C virus antibody -- ALT alanine transaminase -- AST aspartate aminotransferase -- GGT γ-glutamyl transpeptidase -- ALP alkaline phosphatase -- AFP Alpha-foetoprotein -- CA199 carbohydrate antigen 199 -- CEA carcinoembryonic antigen -- PT prothrombin time -- INR international normalized ratio -- MVI microvascular invasion -- RFS Recurrence-free survival -- CART classification and regression tree -- C-index concordance index -- CNLC China liver cancer staging -- CUPI Chinese University Prognostic Index (CUPI) -- CLIP Liver Italian Program system -- JIS Japan Integrated stage -- HR hazard ratio; Oncology -- Periodicals; Cancer -- Surgery -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Cancérologie -- Périodiques; Oncologie; Chirurgie (geneeskunde); Electronic journals; Electronic journals -- Sciences; Electronic journals -- Medicine; Electronic journals; 616.994059005
• DOI: 10.1016/j.ejso.2020.10.039
• Languages: English
• ISSNs: 0748-7983

Abstract

Abstract: Background: Numerous clinical models have been proposed to evaluate and predict recurrence and survival of hepatocellular carcinoma (HCC) patients in different stages after resection, but no model for very early-stage HCC. Methods: The data of 661 very early-stage HCC patients after curative resection in our hospital were retrospectively reviewed. Kaplan-Meier curves and Cox proportional hazards regression models were used to analyze recurrence and survival. The risk classifications for recurrence and survival were established by using classification and regression tree analysis. The nomograms were constructed and validated using bootstrap resampling and an independent 186-patient validation cohort from the same institution. Results: According to the results of multivariate analysis for prognosis after resection, decision trees and 3-stratification classifications that satisfactorily determined the risk of recurrence and survival were established. Based on these two risk classifications, a six-factor nomogram for predicting recurrence and a six-factor nomogram for predicting survival were created. The concordance indexes were 0.64 for recurrence nomogram, with a 95% confidence interval of 0.60–0.67, and 0.76 for survival nomogram, with a 95% confidence interval of 0.70–0.82. The calibration curves showed good agreement between the predictions made by the nomograms and the actual survival outcomes. These predicting results for recurrence and survival were better than three common classical HCC stages and were confirmed in the independent validation cohort. Conclusions: The 3-stratification classifications enabled satisfactory risk evaluations of recurrence and survival, and the nomograms showed considerably accurate predictions of the risk of recurrence and survival in very early-stage HCC patients after curative resection.