Risk and prognostic nomograms for hepatocellular carcinoma with newly-diagnosed pulmonary metastasis using SEER data

Guanzhi Ye,Yunyi Bian,Jiaqi Liang,Zongwu Lin,Cheng Zhan,Lin Wang,Zhengyang Hu

doi:10.7717/peerj.7496

Abstract

PurposeThis research aimed to identify risk factors of pulmonary metastasis (PM) from hepatocellular carcinoma (HCC) and prognostic factors of patients with PM from HCC at initial diagnosis.MethodsPatients diagnosed with HCC between 2010 and 2015 were reviewed retrospectively in the Surveillance, Epidemiology, and End Results (SEER) database. Patients with PM from HCC at initial diagnosis were identified from the entire cohort. Predictors for PM from HCC were identified by multivariate logistic regression analysis. Independent prognostic factors for patients with PM were determined by univariate and multivariate Cox regression analysis. Nomograms were also constructed for quantifying risk of metastasis and overall survival estimation visually.ResultsOur research included 30,641 patients diagnosed with HCC, of whom 1,732 cases were with PM from HCC at initial diagnosis. The risk factors causing PM from HCC were age (P = 0.001), race (P < 0.001), primary tumor size (P < 0.001), T stage (P < 0.001), N stage (P < 0.001), alpha-fetoprotein (P < 0.001), bone metastasis (P < 0.001), brain metastasis (P < 0.001), and intrahepatic metastasis (P < 0.001). The significantly prognostic factors for overall survival were age (P = 0.014), T stage (P = 0.009), surgical approach (P < 0.001), and chemotherapy (P < 0.001). Harrell’s C-index statistics of two nomograms were 0.768 and 0.687 respectively, indicating satisfactory predictive power.ConclusionsThis research provided evaluation of risk factors and prognosis for patients with PM from HCC. Two nomograms we developed can be convenient individualized tools to facilitate clinical decision-making.

Highlights

Liver cancer is one of the most aggressive malignancies and one of the major causes of cancer death globally (Bray et al, 2018)
Because information about the variable CS mets at DX-lung, which indicated the presence or absence of pulmonary metastasis (PM), was not available before 2010, patients diagnosed with Hepatocellular carcinoma (HCC) between 2010 and 2015 were included in our research
The raw measurements of 30,641 patients diagnosed with HCC were provided in Data S1 and raw measurements of 1,732 HCC patients with PM were shown in Data S2

Summary

Introduction

Liver cancer is one of the most aggressive malignancies and one of the major causes of cancer death globally (Bray et al, 2018). Hepatocellular carcinoma (HCC) accounts for 75–85% of primary liver cancer cases. Distant metastasis occurred often in patients with HCC, and lung is the most frequent location of extrahepatic metastasis comprising. Risk and prognostic nomograms for hepatocellular carcinoma with newly-diagnosed pulmonary metastasis using SEER data. Patients with pulmonary metastasis (PM) from HCC have an awfully unfavorable prognosis. The median overall survival (OS) was 4.5 months and 5-year OS rate was only 2.5% for synchronous HCC with PM (Hu et al, 2018). With the progress of therapeutic strategies for primary liver lesion and metastatic lung lesion, the survival of HCC patients with PM has been improved significantly. It is of importance to construct metastatic risk and survival prediction assessment approaches for clinical decision-making

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