Abstract

Background and AimsThis retrospective cohort study developed a prognostic nomogram to predict the survival of hepatocellular carcinoma (HCC) patients diagnosed as beyond Barcelona clinic liver cancer stage A1 after resection and evaluated the possibility of using the nomogram as a treatment algorithm reference.ResultsThe predictors included in the nomogram were total tumour volume, Child-Turcotte-Pugh class, plasma fibrinogen and portal vein tumour thrombus. Patients diagnosed as beyond A1 were stratified into low-, medium- and high-risk groups using nomogram scores of 0 and 51 with the total points of 225. Patients within A1 exhibited similar recurrence-free survival (RFS) and overall survival (OS) rates compared with the low-risk group. Patients in the medium-risk group exhibited a similar OS but a worse RFS rates compared with patients within A1. The high-risk group was associated with worse RFS and OS rates compared with the patients within A1 (3-year RFS rates, 27.0% vs. 60.3%, P < 0.001; 3-year OS rates, 49.2% vs. 83.1%, P < 0.001).MethodsA total of 352 HCC patients undergoing curative resection from September 2003 to December 2012 were included to develop a nomogram to predict overall survival after resection. Univariate and multivariate survival analysis were used to identify prognostic factors. A visually orientated nomogram was constructed using a Cox proportional hazards model.ConclusionsThis user-friendly nomogram offers an individualized preoperative recurrence risk estimation and stratification for HCC patients beyond A1 undergoing resection. Resection should be considered the first-line treatment for low-risk patients.

Highlights

  • Hepatocellular carcinoma (HCC) is a lethal tumour with a prognosis that largely depends on the tumour stage at diagnosis and patient access to radical treatment

  • We explored the possibility of using the nomogram for risk stratification and as a treatment reference by comparing recurrence-free survival (RFS) and overall survival in hepatocellular carcinoma (HCC) patients in or beyond Barcelona Clinic Liver Cancer (BCLC) A1

  • A total of 352 HCC patients undergoing curative surgical resection were included in this study

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Summary

Introduction

Hepatocellular carcinoma (HCC) is a lethal tumour with a prognosis that largely depends on the tumour stage at diagnosis and patient access to radical treatment. Western and Eastern groups validated and approved the Barcelona Clinic Liver Cancer (BCLC) staging system as a guide for HCC treatment algorithms [1,2,3]. Resection of HCC is currently possible in 60% of patients in Asia, and www.impactjournals.com/oncotarget. This retrospective cohort study developed a prognostic nomogram to predict the survival of hepatocellular carcinoma (HCC) patients diagnosed as beyond Barcelona clinic liver cancer stage A1 after resection and evaluated the possibility of using the nomogram as a treatment algorithm reference

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