Prognostic Stratification Based on a Novel Nomogram for Solitary Large Hepatocellular Carcinoma After Curative Resection

Abstract

Solitary large hepatocellular carcinoma (SLHCC) is a specific subtype of HCC with unique characteristics. It is of great interest to assess and stratify the prognosis of SLHCCs after curative resection. In this study, we tried to construct a prognostic nomogram for SLHCC following curative resection through a retrospective analysis of 202 SLHCC cases. Seven prognostic factors were identified and integrated to establish a novel prognostic nomogram, which included tumor size, microvascular invasion, tumor differentiation, Ki67 (%), α-fetoprotein (AFP), carbohydrate antigen 125 (CA125), and HBsAg status. The Harrell's concordance index (C-index) of the nomogram for overall survival (OS) in the training, validation, and whole sets was 0.752, 0.703, and 0.733, respectively. Furthermore, the area under the curve (AUC) of the receiver operating characteristic (ROC) curve of the nomogram for predicting 1-, 3-, and 5-year OS indicated that the nomogram had an optimal discrimination of the prognostic prediction for SLHCC. The total score of each patient was calculated based on the nomogram, and patients were divided into three subgroups: low-risk group (total score ≦ 107), medium-risk group (107 < total score ≤ 125), and high-risk group (total score > 125). The 1-, 3-, and 5-year OS rates of the low-risk, medium-risk, and high-risk groups in the whole set were 89.3 vs. 70.1 vs. 33.3%, 76.6 vs. 37.8 vs. 14.5%, and 69.8 vs. 25.1 vs. 12.5%, respectively ( P < 0.001). Similar results were shown in terms of the recurrence-free survival (RFS) rate. By analyzing 101 cases of recurrent tumors, transarterial chemoembolization (TACE) plus radiofrequency ablation (RFA)/surgery was found to prolong patient survival when compared to TACE alone in the low-risk group, but not in the medium/high-risk group. In conclusion, our prognostic nomogram successfully stratifies the prognosis for SLHCC after curative resection, which deserves further study in future clinical practice.

Two-Trait Predictor of Venous Invasion on Contrast-Enhanced CT as a Preoperative Predictor of Outcomes for Early-Stage Hepatocellular Carcinoma After Hepatectomy

“…In addition, an intact capsule appearance observed by CT is indicative of a lower probability of MVI being present in the surrounding liver parenchyma (29,30). In this study, the multivariate analysis of AFP was adjusted for clinical variables for OS confirmed in previous reports (31,32). Notably, preoperative serum AFP may be an indirect indicator of tumor burden.…”

“…Notably, preoperative serum AFP may be an indirect indicator of tumor burden. In fact, several studies have reported that an elevated AFP serum level is one of the crucial factors heralding poor survival after surgical resection, radiofrequency ablation, and transcatheter arterial chemoembolization of HCC (31)(32)(33)(34).…”

Transarterial Chemoembolization in Treatment-Naïve and Recurrent Hepatocellular Carcinoma: A Propensity-Matched Outcome and Risk Signature Analysis

“…Recurrence and survival after TACE in both groups are critical to the prognosis of patients. Zhuang et al (26) incorporated seven prognostic factors to construct a prognostic nomogram, and concluded that TACE combining with RFA was beneficial in patients with recurrent HCC in the low-risk group after LR, while TACE alone was sufficient for patients in the medium/high-risk group. Meanwhile, Lu et al (27) retrospectively analyzed clinical data from 597 HCC patients treated with TACE, suggesting that elevated platelet was associated with poor survival in HCC patients.…”

“…Zhuang et al. ( 26 ) incorporated seven prognostic factors to construct a prognostic nomogram, and concluded that TACE combining with RFA was beneficial in patients with recurrent HCC in the low-risk group after LR, while TACE alone was sufficient for patients in the medium/high-risk group. Meanwhile, Lu et al.…”

Feasibility and safety of liver resection for huge hepatocellular carcinoma in cirrhotics

“…[22][23][24][25] The current literature showed that in carefully selected patients with huge HCC would benefit from liver resection as upfront treatment approach. 10,[26][27][28] Likewise, several comparative studies documented the superiority of liver resection for huge HCC compared with TACE regarding overall and recurrence-free survival. 1,29,30 Liver cirrhosis, the most common risk factor for development of HCC, was known to impair liver regeneration.…”