Postoperative outcomes and recurrence patterns of intermediate-stage hepatocellular carcinoma dictated by the sum of tumor size and number

A novel nomogram based on the hematological prognosis risk scoring system can predict the overall survival of patients with hepatocellular carcinoma

BACKGROUND

This study aimed to establish and validate a nomogram based on a hematological prognostic risk scoring system to predict the overall survival in patients with unresectable hepatocellular carcinoma (HCC).

MATERIALS AND METHODS

Patients diagnosed with unresectable HCC undergoing transcatheter arterial chemoembolization (TACE) in 2012-2016 and 2017-2018 were included in the development set and validation set, respectively. The clinical outcome was overall survival (OS). The LASSO regression analysis was used to construct a hematological prognostic risk scoring system (HPR) by using the 18 hematological markers of patients in the development set. Combining the features of oncology on the basis of HPR to construct a nomogram for OS. In the development set and validation sets, the C-index, calibration curve, and decision curve analysis (DCA) were used to evaluate the prediction performance of the nomogram.

RESULTS

Multiple markers of immunity, coagulation, liver function, and nutrition, including red blood cell distribution width-coefficient of variation (RDW-CV), platelet (PLT), aspartate transferase (AST), alkaline phosphatase (ALP), prognostic nutritional index (PNI), and fibrinogen (Fib), construct the HPR. HPR was an independent risk factor for OS in patients with HCC. The C-index of the nomogram was 0.731 (95% confidence interval (CI) 0.712-0.749) and 0.696 (95% CI 0.668-0.725) in the development set and the validation set, respectively.

CONCLUSIONS

HPR was a complement to the clinical features of patients with unresectable HCC. The nomogram based on HPR proved to be a practical and effective method for prognosticating HCC patients who undergo TACE.

External validation and improvement of the scoring system for predicting the prognosis in hepatocellular carcinoma after interventional therapy

Background

Currently, locoregional therapies, such as transarterial chemoembolization (TACE) and ablation, play an important role in the treatment of Hepatocellular carcinoma (HCC). However, an easy-to-use scoring system that predicts recurrence to guide individualized management of HCC with varying risks of recurrence remains an unmet need.

Methods

A total of 483 eligible HCC patients treated by TACE combined with ablation from January 1, 2017, to December 31, 2019, were included in the temporal external validation cohort and then used to explore possibilities for refinement of the original scoring system. We investigated the prognostic value of baseline variables on recurrence-free survival (RFS) using a Cox model and developed the easily applicable YA score. The performances of the original scoring system and YA score were assessed according to discrimination (area under the receiver operating curve [AUROC] and Harrell's concordance index [C-statistic]), calibration (calibration curves), and clinical utility [decision curve analysis (DCA) curves]. Finally, improvement in the ability to predict in the different scoring systems was assessed using the Net Reclassification Index (NRI). The YA score was lastly compared with other prognostic scores.

Results

During the median follow-up period of 35.6 months, 292 patients experienced recurrence. In the validation cohort, the original scoring system exhibited high discrimination (C-statistic: 0.695) and calibration for predicting the prognosis in HCC. To improve the prediction performance, the independent predictors of RFS, including gender, alpha-fetoprotein (AFP) and des-γ-carboxyprothrombin (DCP), tumor number, tumor size, albumin-to-prealbumin ratio (APR), and fibrinogen, were incorporated into the YA score, an improved score. Compared to the original scoring system, the YA score has better discrimination (c-statistic: 0.712VS0.695), with outstanding calibration and the clinical net benefit, both in the training and validation cohorts. Moreover, the YA score accurately stratified patients with HCC into low-, intermediate- and high-risk groups of recurrence and mortality and outperformed other prognostic scores.

Conclusion

YA score is associated with recurrence and survival in early- and middle-stage HCC patients receiving local treatment. Such score would be valuable in guiding the monitoring of follow-up and the design of adjuvant treatment trials, providing highly informative data for clinical management decisions.