Cancer Res Treat.  2019 Oct;51(4):1464-1478. 10.4143/crt.2018.657.

Novel Prognostic Nomograms Based on Inflammation-Related Markers for Patients with Hepatocellular Carcinoma Underwent Hepatectomy

• Wang Y
• Sun K
• Shen J
• Li B
• Kuang M
• Cao Q
• Peng S

• KMID: 2460595
• DOI: http://doi.org/10.4143/crt.2018.657

Abstract

PURPOSE
Hepatocellular carcinoma (HCC) is an aggressive disease with high recurrence rate. However, current staging systems were lack of predictive capacity for HCC recurrence. We aimed to develop prognostic nomograms based on inflammation-related markers for HCC patients underwent hepatectomy.
MATERIALS AND METHODS
We recruited 889 surgically treated patients from two medical centers. Independent prognostic factors were identified by cox regression analyses. Nomograms for recurrence-free survival (RFS) and overall survival (OS) were established, and validated internally and externally. The performance, discrimination, and calibration of nomograms were assessed, and compared with existed staging systems.
RESULTS
Neutrophil to lymphocyte ratio (NLR) and gamma-glutamyl transpeptidase to platelet ratio (GPR) were the two inflammation-related factor that independently correlated with survival. NLR, GPR, international normalized ratio (INR), microvascular invasion, satellite lesions, tumour number, tumour diameter, and macrovascular invasion were used to construct nomogram for RFS while GPR, total bilirubin, INR, α-fetoprotein, microvascular invasion, satellite lesions, tumour diameter, and macrovascular invasion were for OS. In the training cohort, the C-index of nomogram was 0.701 (95% confidence interval [CI], 0.669 to 0.732) for RFS and 0.761 (95% CI, 0.728 to 0.795) for OS. These results received both internal and external validation with C-index of 0.701 (95% CI, 0.647 to 0.755) and 0.707 (95% CI, 0.657 to 0.756) for RFS, and 0.706 (95% CI, 0.640 to 0.772) and 0.708 (95% CI, 0.646 to 0.771) for OS, respectively. The nomograms showed superior accuracy to conventional staging systems (p<0.001).
CONCLUSION
The nomograms based on inflammation-related markers are of high efficacy in predicting survival of HCC patients after hepatectomy, which will be valuable in guiding postoperative interventions and follow-ups.

Keyword

Hepatocellular carcinoma; Inflammation; Resection; Survival; Nomograms

MeSH Terms

Bilirubin
Blood Platelets
Calibration
Carcinoma, Hepatocellular*
Cohort Studies
Discrimination (Psychology)
Follow-Up Studies
gamma-Glutamyltransferase
Hepatectomy*
Humans
Inflammation
International Normalized Ratio
Lymphocytes
Neutrophils
Nomograms*
Recurrence
Bilirubin
gamma-Glutamyltransferase

Figure

• 

  Fig. 1. The workflow diagram of patient selection. HCC, hepatocellular carcinoma; HBsAg, hepatitis B virus surface antigen; FAHSYSU, First Affiliated Hospital of Sun Yat-sen University; SYSUCC, Sun Yat-sen University Cancer Center.

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  Fig. 2. Nomograms for predicting recurrence-free survival (A) and overall survival (B). NLR, neutrophil to lymphocyte ratio; GPR, gamma-glutamyl transpeptidase to platelet ratio; INR, international normalized ratio; TBIL, total bilirubin; AFP, α-fetoprotein.

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  Fig. 3. The calibration curves for predicting the 1-, 2-, and 3-year recurrence-free survival and overall survival in the training (A, B), internal validation (C, D), and external validation (E, F) cohorts.

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  Fig. 4. Receiver operating characteristic curves for recurrence-free survival and overall survival in the training (A, B), internal validation (C, D), and external validation (E, F) cohorts, respectively.

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  Fig. 5. Patients’ recurrence-free survival and overall survival rates according to the nomogram model in the training (A, B), internal validation (C, D), and external validation (E, F) cohorts. Green line for high-risk, red line for medium-risk, blue line for low-risk.

Reference

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