Prognostic significance of controlling nutritional status score-based nomogram for hepatocellular carcinoma within Milan criteria after radiofrequency ablation.

BACKGROUND

Radiofrequency ablation (RFA) is a curative therapy for hepatocellular carcinoma (HCC) within Milan criteria. This study was conducted to evaluate the association between controlling nutritional status (CONUT) score and oncological outcomes in HCC patients within Milan criteria after RFA. Nomograms were constructed for the prediction of prognosis.

METHODS

The study included 403 HCC patients within Milan criteria who underwent RFA at National Cancer Center and the First Hospital of Shanxi Medical University from January 2010 to December 2014. Oncological outcomes included disease-free survival (DFS) and overall survival (OS). The clinical variables were assessed by univariate and multivariate Cox regression analyses. C-index, time-dependent receiver operating characteristic (t-ROC) curve (t-AUC) and calibration plots were used to evaluate discrimination and calibration of the nomograms.

RESULTS

Patients were divided into CONUT ≤4 and ≥5 groups. The common prognostic factors affecting DFS and OS were number of lesions, tumor differentiation, and CONUT score. Age and total bilirubin (TBIL) were prognostic factors for OS only. Both DFS and OS rates in CONUT ≤4 group were significantly higher than those in CONUT ≥5 group (P=0.033, P<0.001). Two well-discriminated and calibrated nomograms were constructed to predict the probability of 1-, 2-, and 3-year DFS and 1-, 2-, 3-, 5-year OS with C-indexes of 0.798 and 0.757, respectively.

CONCLUSIONS

CONUT score is an independent prognostic factor for HCC after RFA treatment and a reliable indicator for nutritional interventions. Higher CONUT scores were associated with poor oncological outcomes. Nomograms based on CONUT score could efficiently predict DFS and OS for HCC patients within Milan criteria after RFA.