Abstract
Objective: This study aimed to develop and validate a simple-to-use nomogram for early hepatocellular carcinoma (HCC) patients undergoing a preoperative consultation and doctors conducting a postoperative evaluation.Methods: A total of 2,225 HCC patients confirmed with stage I or II were selected from the Surveillance, Epidemiology, and End Results database between January 2010 and December 2015. The patients were randomly divided into two groups: a training group (n = 1,557) and a validation group (n = 668). Univariate and multivariate hazards regression analyses were used to identify independent prognostic factors. The Akaike information criterion (AIC) was used to select variables for the nomogram. The performance of the nomogram was validated concerning its ability of discrimination and calibration and its clinical utility.Results: Age, alpha-fetoprotein (AFP), race, the degree of differentiation, and therapy method were significantly associated with the prognosis of early HCC patients. Based on the AIC results, five variables (age, race, AFP, degree of differentiation, and therapy method) were incorporated into the nomogram. The concordance indexes of the simple nomogram in the training and validation groups were 0.707 (95% CI: 0.683–0.731) and 0.733 (95% CI: 0.699–0.767), respectively. The areas under the receiver operating characteristic (ROC) curve of the nomogram in the training and validation groups were 0.744 and 0.764, respectively, for predicting 3-year survival, and 0.786 and 0.794, respectively, for predicting 5-year survival. Calibration plots showed good consistency between the predictions of the nomogram and the actual observations in both the training and validation groups. Decision curve analysis (DCA) showed that the simple nomogram was clinically useful, and the overall survival significantly differed between low- and high-risk groups divided by the median score of the nomogram in the training group (P < 0.001).Conclusion: A simple-to-use nomogram based on a large population-based study is developed and validated, which is a conventional tool for doctors to facilitate the individual consultation of preoperative patients and the postoperative personalized evaluation.
Highlights
Hepatocellular carcinoma (HCC), accounting for 75–85% of primary hepatic carcinoma (PHC), is the fourth leading cause of cancer death globally in 2018 [1]
Early HCC treated with surgical resection has an ∼70% of 5-year survival rate [3], the remaining 30% of early HCC patients still have a poor outcome
It was found that there was no significant difference in overall survival between stage I and stage II based on the TNM staging system [6], which indicated that this staging system could not predict the personalized prognosis of early HCC
Summary
Hepatocellular carcinoma (HCC), accounting for 75–85% of primary hepatic carcinoma (PHC), is the fourth leading cause of cancer death globally in 2018 [1]. The prognosis of HCC is associated with the stage of tumor [2]. Careful evaluation of the prognosis is still needed for early HCC. Accurate prognostic evaluation is an important step in the management of patients with HCC. The TNM staging system (American Joint Committee on Cancer, AJCC), which was first published in 1977 and is widely used in the clinic, has been updated to the eighth edition [4]. The TNM staging system did not perform well in HCC prognosis [5]. It was found that there was no significant difference in overall survival between stage I and stage II based on the TNM staging system [6], which indicated that this staging system could not predict the personalized prognosis of early HCC. An easy-touse and personalized scoring system is still needed to predict the prognosis of early HCC
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
