Impact of tumor burden on prognostic prediction for patients with terminal stage hepatocellular carcinoma: A nomogram study

Abstract

BackgroundThe recently proposed nomogram of Barcelona Clinic Liver Cancer (BCLC) lacks predictive accuracy for patients with stage D hepatocellular carcinoma (HCC). Tumor burden is crucial in prognostic prediction but is not included in the criteria of stage D HCC. This study aims to develop a nomogram with tumor burden as the core element for BCLC stage D patients.MethodsA total of 386 patients were randomly grouped into derivation and validation sets (1:1 ratio). The multivariate Cox proportional hazards model was used to select factors with significant prognostic effect and generate the nomogram. Concordance indices and calibration plots were used to evaluate the performance of nomogram.ResultsOverall survival of study patients was significantly associated with tumor burden as well as hepatitis B, serum α-fetoprotein level, cirrhosis and performance status in multivariate Cox regression (all p<0.05). Beta-coefficients of these variables in derivation set were used to generate the nomogram. Each patient was assigned with a total nomogram point that predicted individualized 6-month and 1-year survival. The derivation and validation sets had a c-index of 0.759 (95% confidence interval [CI]: 0.552–0.923) and 0.741 (95% CI: 0.529–0.913), respectively. The calibration plots were close to the 45-degree line for 6-month and 1-year survival prediction for all quarters of patients in both derivation and validation sets.ConclusionTumor burden is significantly associated with the outcome for patients with stage D HCC. The tumor burden-incorporated nomogram may serve as a feasible and easy-to-use tool in predicting survival on an individual level.

Metastasis in patients with hepatocellular carcinoma: Prevalence, determinants, prognostic impact and ability to improve the Barcelona Clinic Liver Cancer system

“…Vascular invasion and metastasis are well‐known predictors of poor survival in HCC patients . In our study, patients with a combination of both factors had a significantly worse outcome compared to patients with vascular invasion alone or metastasis alone.…”

“…This design of BCLC would make the predicted prognosis between stage C and D patients overlap substantially . Recently, the co‐existence of vascular invasion and metastasis was found to associate with a significantly worse prognosis of BCLC stage C patients, and another independent study showed that tumour burden is a strong prognostic factor for stage D patients . These results prompted us to perform an in‐depth investigation regarding the associated elements and prognostic effect of metastasis and also the possibility of integrating tumour behaviour into the BCLC system to further improve its predictive accuracy.…”

“…However, patients with large tumour volume, vascular invasion and distant metastases may still not be regarded as terminal stage if they have preserved liver function and PS. Our recent study disclosed the significant prognostic effect of tumour burden on BCLC stage D HCC patients, and currently, there is no study supporting that the predictive accuracy of BCLC system might be improved by integrating tumour burden into the criteria of BCLC stage D.…”

Prognostic significance of the sum of the diameters of single foci in multifocal papillary thyroid cancer: the concept of new-old tumor burden

“…There is certainly plenty of evidence to suggest that tumor burden has prognostic value in numerous human tumors. 32 – 37 In the particular case of multifocal PTC, SDSF may reflect the tumor burden better than the size of the largest focus, that is, PTS. This impression is supported by the SDSF-revised T-categories showing an even stronger association with persistence/recurrence ( p = 0.0003 versus p = 0.01) in our series than the T-categories based on PTS.…”

No Association Between MicroRNA-608 rs4919510 G>C Polymorphism and Digestive System Cancers Susceptibility: A Meta-Analysis Based on 10,836 Individuals

“…According to the recent published cancer statistics, there were approximately 310,440 new DSCs cases and 157,700 DSCs-related deaths in United States in 2017 (Siegel et al, 2017 ). The treatment and care of patients with DSCs result in a heavy economic and psychological burden to both society and the patient's family (Hsu et al, 2017 ; Jinjuvadia et al, 2017 ). Surgery, radiotherapy, chemotherapy and other treatments may cause extensive damage to patients' tissues and organs and may result in various complications that lead to local dysfunction and seriously decrease the quality of life of patients (Nederlof et al, 2016 ; Bosch et al, 2017 ; Motoyama et al, 2017 ).…”