Abstract
Albumin to gamma-glutamyltransferase ratio (AGR) is a newly developed biomarker for the prediction of patients' prognosis in solid tumors. The purpose of the study was to establish a novel AGR-based nomogram to predict tumor prognosis in patients with early-stage HCC undergoing radiofrequency ablation (RFA). 394 hepatocellular carcinoma (HCC) patients who had received RFA as initial treatment were classified into the training cohort and validation cohort. Independent prognostic factors were identified by univariate and multivariate analyses. The value of AGR was evaluated by the concordance index (C-index), receiver operating characteristic (ROC) curves, and likelihood ratio tests (LAT). Logistic regression and nomogram were performed to establish the pretreatment scoring model based on the clinical variables. As a result, AGR = 0.63 was identified as the best cutoff value to predict overall survival (OS) in the training cohort. According to the results of multivariate analysis, AGR was an independent indicator for OS and recurrence-free survival (RFS). In both training cohort and validation cohort, the high-AGR group showed better RFS and OS than the low-AGR group. What is more, the C-index, area under the ROC curves, and LAT χ2 values suggested that AGR outperformed the Child-Pugh (CP) grade and albumin-bilirubin (ALBI) grade in terms of predicting OS. The AGR, AKP, and tumor size were used to establish the OS nomogram. Besides, the results of Hosmer-Lemeshow test and calibration curve analysis displayed that both nomograms in the training and validation cohorts performed well in terms of calibration. Therefore, the AGR-based nomogram can predict the postoperative prognosis of early HCC patients undergoing RFA.
Highlights
Primary liver cancer can be divided into three types: hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma, and combined hepatocellular and cholangiocarcinoma [1]
radiofrequency ablation (RFA) is an effective method for the management of small liver cancer
Evaluating the survival time of HCC patients after treatment is of great significance for formulating reasonable treatment plans and improving the quality of life of patients with HCC
Summary
Primary liver cancer can be divided into three types: hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma, and combined hepatocellular and cholangiocarcinoma [1]. HCC is one of the most common malignancies in humans and the second leading cause of cancer-related deaths in men in developing countries [2, 3]. Tumor ablation is a widely accepted treatment choice for patients with early stage HCC. Radiofrequency ablation (RFA) is the preferred ablation technique because it provides better disease control than percutaneous ethanol injection [6]. This difference is pronounced in tumor nodules with a diameter of more than 2 cm. In HCC patients with Child-Pugh (CP) A, the survival rate after ablation is similar to those undergoing surgical resection [7]. Previous studies have proved that the long-term therapeutic effect of RFA for patients with small HCC is equivalent to liver resection and liver transplantation [8, 9]
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