Gut Liver.  2019 Nov;13(6):669-682. 10.5009/gnl18489.

Novel Prognostic Nomograms for Hepatocellular Carcinoma Patients with Microvascular Invasion: Experience from a Single Center

• Xu L
• Li L
• Wang P
• Zhang M
• Zhang Y
• Hao X
• Yan L
• Li B
• Wen T
• Xu M

• KMID: 2464314
• DOI: http://doi.org/10.5009/gnl18489

Abstract

BACKGROUND/AIMS
Microvascular invasion (MVI) is an established risk factor for hepatocellular carcinoma (HCC). However, prediction models that specifically focus on the individual prognoses of HCC patients with MVI is lacking.
METHODS
A total of 385 HCC patients with MVI were randomly assigned to training and validation cohorts in a 2:1 ratio. The outcomes were disease-free survival (DFS) and overall survival (OS). Prognostic nomograms were established based on the results of multivariate analyses. The concordance index (C-index), calibration plots and Kaplan-Meier curves were employed to evaluate the accuracy, calibration and discriminatory ability of the models.
RESULTS
The independent risk factors for both DFS and OS included age, tumor size, tumor number, the presence of gross vascular invasion, and the presence of Glisson's capsule invasion. The platelet-to-lymphocyte ratio was another risk factor for OS. On the basis of these predictors, two nomograms for DFS and OS were constructed. The C-index values of the nomograms for DFS and OS were 0.712 (95% confidence interval [CI], 0.679 to 0.745; p<0.001) and 0.698 (95% CI, 0.657 to 0.739; p<0.001), respectively, in the training cohort and 0.704 (95% CI, 0.650 to 0.708; p<0.001) and 0.673 (95% CI, 0.607 to 0.739; p<0.001), respectively, in the validation cohort. The calibration curves showed optimal agreement between the predicted and observed survival rates. The Kaplan-Meier curves suggested that these two nomograms had satisfactory discriminatory abilities.
CONCLUSIONS
These novel predictive models have satisfactory accuracy and discriminatory abilities in predicting the prognosis of HCC patients with MVI after hepatectomy.

Keyword

Carcinoma, hepatocellular; Microvascular invasion; Hepatectomy; Prognosis; Nomogram

MeSH Terms

Calibration
Carcinoma, Hepatocellular*
Cohort Studies
Disease-Free Survival
Hepatectomy
Humans
Multivariate Analysis
Nomograms*
Prognosis
Risk Factors
Survival Rate