Cooley's anaemia in a Maltese child.

Abstract

<h3>Background</h3> Hepatocellular carcinoma (HCC) is an aggressive disease with high recurrence rate. However, current staging systems were lack of predictive capacity for HCC recurrence after hepatic resection. We aimed to develop prognostic nomograms based on inflammation-related markers for HCC patients underwent hepatectomy. <h3>Methods</h3> We retrospectively recruited 1350 surgically treated HCC patients from two medical centres between November 2003 and December 2017. All established inflammation-related markers were enrolled in analysis for selecting the best in predicting recurrence-free survival (RFS) and overall survival (OS). Independent prognostic factors were identified by cox regression analyses. Nomograms for estimating the probability of 1-, 2-, 3-year RFS and OS were established, and validated internally and externally. The performance, discrimination and calibration of nomograms were assessed, and compared with conventional staging systems including Barcelona Clinic Liver Cancer (BCLC) and 7^th American Joint Committee on Cancer (AJCC). <h3>Results</h3> Gamma-glutamyl transpeptidase to platelet ratio (GPR) was the only inflammation-related factor that independently correlated with both RFS and OS. GPR, international normalized ratio (INR), alpha-fetoprotein (AFP), microvascular invasion, satellite lesions, tumour number, tumour diameter and macrovascular invasion were used to construct nomogram for RFS while GPR, AFP, microvascular invasion, satellite lesions and macrovascular invasion were for OS (figure 1). In the training cohort, the C-index of nomogram was 0.713 (95% confidence interval [CI], 0.690–0.738) for RFS and 0.774 (95%CI, 0.747–0.801) for OS. These results received both internal and external validation with C-index of 0.707 (95%CI, 0.662–0.753) and 0.710 (95%CI, 0.665–0.756) for RFS, and 0.747 (95%CI, 0.686–0.807) and 0.711 (95%CI, 0.641–0.780) for OS, respectively. The calibration curves for RFS and OS rates were all well-matched with the standard lines. The nomograms showed superior accuracy to existed staging systems (<i>P</i>&lt;0.001). <h3>Conclusions</h3> The novel nomograms based on preoperative 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.