Preoperative and postoperative nomograms for predicting early recurrence of hepatocellular carcinoma without macrovascular invasion after curative resection

Abstract

Background Postoperative early recurrence (ER) is a major obstacle to long-term survival after curative liver resection (LR) in patients with hepatocellular carcinoma (HCC). This study aimed to establish preoperative and postoperative nomograms to predict ER in HCC without macrovascular invasion. Methods Patients who underwent curative LR for HCC between January 2012 and December 2016 were divided into training and internal prospective validation cohorts. Nomograms were constructed based on independent risk factors derived from the multivariate logistic regression analyses in the training cohort. The predictive performances of the nomograms were validated using the internal prospective validation cohort. Results In total, 698 patients fulfilled the eligibility criteria. Among them, 265 of 482 patients (55.0%) in the training cohort and 120 of 216 (55.6%) patients in the validation cohort developed ER. The preoperative risk factors associated with ER were age, alpha-fetoprotein, tumor diameter, and tumor number, and the postoperative risk factors associated with ER were age, tumor diameter, tumor number, microvascular invasion, and differentiation. The pre- and postoperative nomograms based on these factors showed good accuracy, with concordance indices of 0.712 and 0.850 in the training cohort, respectively, and 0.754 and 0.857 in the validation cohort, respectively. The calibration curves showed optimal agreement between the predictions by the nomograms and actual observations. The area under the receiver operating characteristic curves of the pre- and postoperative nomograms were 0.721 and 0.848 in the training cohort, respectively, and 0.754 and 0.844 in the validation cohort, respectively. Conclusions The nomograms constructed in this study showed good performance in predicting ER for HCC without macrovascular invasion before and after surgery. These nomograms would be helpful for doctors when determining treatments and selecting patients for regular surveillance or administration of adjuvant therapies.

Revolutionising hepatocellular carcinoma surveillance: Harnessing contrast-enhanced ultrasound and serological indicators for postoperative early recurrence prediction

“…This finding further reinforces the significance of tumor size in HCC outcomes and treatment planning. [ 46 ] The association between larger tumor diameter and an elevated risk of tumor recurrence can be attributed to several underlying factors. Larger tumors often indicate an advanced disease stage, suggesting a more extensive tumor burden, increased rates of vascular invasion, and a higher likelihood of occult micrometastases.…”

Macroscopic Characterization of Hepatocellular Carcinoma: An Underexploited Source of Prognostic Factors

“…A recent study including 698 HCC patients undergoing LR showed that TS >10 cm was an independent prognostic factor of early recurrence within 2 years with an odds ratio (OR) of 1.72 (95% CI, 1.20–2.46; p = 0.003). 13 After inclusion of size in nomograms, the predictive accuracy was confirmed in both training and validation cohorts. Of note, it included only patients without macroscopic vascular invasion (MaVI).…”

Novel postoperative nomograms for predicting individual prognoses of hepatitis B-related hepatocellular carcinoma with cirrhosis

“…The cut-off values of continuous blood test variables were determined using the normal reference values, meanwhile, the cut-off values of age, AFP and intraoperative blood loss were determined age-specific cut-off values. AFP level and intraoperative blood loss were determined according the information reported in previous medical studies [ 25 – 27 ]. Categorical variables are expressed as number or percentage and were compared using Pearson’s Chi-square test or Fisher’s exact test.…”