Prognostic Nomograms Stratify Survival of Patients with Hepatocellular Carcinoma Without Portal Vein Tumor Thrombosis After Curative Resection.

BACKGROUND

The prognosis of patients with hepatocellular carcinoma (HCC) without portal vein tumor thrombosis (PVTT) after curative resection is at variance. We identified the risk factors of poor postoperative prognosis and consequently developed prognostic nomograms generating individual risk of death and recurrence for this subgroup of patients with HCC.

METHODS

The risk factors were identified and nomograms were developed based on a retrospective study of 734 patients in the primary cohort who underwent curative resection for HCC from 2010 to 2012. The predictive accuracy and discriminative ability of the nomograms were determined by concordance index (C-index) and calibration curve and compared with traditional staging systems of HCC. The results were validated in an independent cohort of 349 patients operated at the same institution in 2007.

RESULTS

All of the independent factors for survival in multivariate analysis in the primary cohort were selected into the nomograms. The calibration curve for probability of survival showed good agreement between prediction by nomograms and actual observation. The C-indices of the nomograms for predicting overall survival and recurrence-free survival were 0.755 (95% confidence interval [CI], 0.752-0.758) and 0.665 (95% CI, 0.662-0.668), respectively, which were statistically higher than the C-indices of other HCC prognostic models. The results were further confirmed in the validation cohort.

CONCLUSION

The proposed nomograms resulted in more accurate prognostic prediction for patients with HCC without PVTT after curative resection. 2017;22:561-569 IMPLICATIONS FOR PRACTICE: Hepatocellular carcinoma (HCC) poses a great therapeutic challenge due to the poor prognosis in patients underwent surgical resection. The portal vein tumor thrombosis (PVTT) as a robust risk factor for survival has been routinely integrated to staging systems. Nonetheless, the prognosis stratification for patients without PVTT was neglected to some extent. Herein, independent risk factors of OS and RFS in HCC patients without PVTT were reconfirmed. A predictive nomogram was constructed on these risk factors and was demonstrated to be a more accurate predictive model in HCC patients without PVTT, compared with the traditional staging systems.