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Cancer Commun (Lond). 2019 Oct 11;39(1):55. doi: 10.1186/s40880-019-0404-6.

A nomogram predicting the recurrence of hepatocellular carcinoma in patients after laparoscopic hepatectomy.

Pan YX1,2, Chen JC1,2, Fang AP3, Wang XH1,2, Chen JB1,2, Wang JC1,2, He W1,2, Fu YZ1,2, Xu L1,2, Chen MS1,2, Zhang YJ1,2, Li QJ4,5, Zhou ZG6,7,8.

Author information

1
State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.
2
Department of Liver Surgery, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, P. R. China.
3
Department of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong, P. R. China.
4
State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China. liqj@sysucc.org.cn.
5
Department of Liver Surgery, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, P. R. China. liqj@sysucc.org.cn.
6
State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China. zhouzhg@sysucc.org.cn.
7
Department of Liver Surgery, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, P. R. China. zhouzhg@sysucc.org.cn.
8
Department of Molecular Medicine California Campus, The Scripps Research Institute, 10550, North Torrey Pines Road, La Jolla, CA, 92037, USA. zhouzhg@sysucc.org.cn.

Abstract

BACKGROUND:

Patients with hepatocellular carcinoma (HCC) undergoing surgical resection still have a high 5-year recurrence rate (~ 60%). With the development of laparoscopic hepatectomy (LH), few studies have compared the efficacy between LH and traditional surgical approach on HCC. The objective of this study was to establish a nomogram to evaluate the risk of recurrence in HCC patients who underwent LH.

METHODS:

The clinical data of 432 patients, pathologically diagnosed with HCC, underwent LH as initial treatment and had surgical margin > 1 cm were collected. The significance of their clinicopathological features to recurrence-free survival (RFS) was assessed, based on which a nomogram was constructed using a training cohort (n = 324) and was internally validated using a temporal validation cohort (n = 108).

RESULTS:

Hepatitis B surface antigen (hazard ratio [HR], 1.838; P = 0.044), tumor number (HR, 1.774; P = 0.003), tumor thrombus (HR, 2.356; P = 0.003), cancer cell differentiation (HR, 0.745; P = 0.080), and microvascular tumor invasion (HR, 1.673; P  =0.007) were found to be independent risk factors for RFS in the training cohort, and were used for constructing the nomogram. The C-index for RFS prediction in the training cohort using the nomogram was 0.786, which was higher than that of the 8th edition of the American Joint Committee on Cancer TNM classification (C-index, 0.698) and the Barcelona Clinic Liver Cancer staging system (C-index, 0.632). A high consistency between the nomogram prediction and actual observation was also demonstrated by a calibration curve. An improved predictive benefit in RFS and higher threshold probability of the nomogram were determined by receiver operating characteristic curve analysis, which was also confirmed in the validation cohort compared to other systems.

CONCLUSIONS:

We constructed and validated a nomogram able to quantify the risk of recurrence after initial LH for HCC patients, which can be clinically implemented in assisting the planification of individual postoperative surveillance protocols.

KEYWORDS:

American Joint Committee on Cancer TNM classification; Barcelona Clinic Liver Cancer staging system; Hepatitis B surface antigen; Hepatocellular carcinoma; Laparoscopic hepatectomy; Nomogram; Recurrence; Tumor invasion; Tumor thrombus

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