Prognostic Nomograms for Patients with Hepatocellular Carcinoma After Curative Hepatectomy, with a Focus on Recurrence Timing and Post-Recurrence Management
Wei Xu,* Fei Liu,* Xianbo Shen,* Ruineng Li Department of Hepatobiliary Surgery, Hunan Provincial People’s Hospital, The First Hospital Affiliated with Hunan Normal University, Changsha, People’s Republic of China*These authors contributed equally to this workCorrespondence: Wei...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2020-10-01
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| Series: | Journal of Hepatocellular Carcinoma |
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| Online Access: | https://www.dovepress.com/prognostic-nomograms-for-patients-with-hepatocellular-carcinoma-after--peer-reviewed-article-JHC |
| _version_ | 1819169721948307456 |
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| author | Xu W Liu F Shen X Li R |
| author_facet | Xu W Liu F Shen X Li R |
| author_sort | Xu W |
| collection | DOAJ |
| description | Wei Xu,* Fei Liu,* Xianbo Shen,* Ruineng Li Department of Hepatobiliary Surgery, Hunan Provincial People’s Hospital, The First Hospital Affiliated with Hunan Normal University, Changsha, People’s Republic of China*These authors contributed equally to this workCorrespondence: Wei XuDepartment of Hepatobiliary Surgery, Hunan Provincial People’s Hospital, The First Hospital Affiliated with Hunan Normal University, Changsha, People’s Republic of ChinaTel +86 13873159491Fax +86 73182278012Email xuwei0209@163.comBackground: Prognoses of patients with hepatocellular carcinoma (HCC) after curative hepatectomy remain unsatisfactory because of the high incidence of postoperative recurrence. Published predictive systems focus on pre-resection oncological characteristics, ignoring post-recurrence factors.Purpose: This study aimed to develop prognostic nomograms for 3- and 5-year overall survival (OS) of patients with HCC after curative hepatectomy, focusing on potentially influential post-recurrence factors.Patients and Methods: Clinicopathological and postoperative follow-up data were extracted from 494 patients with HCC who underwent curative hepatectomy between January 2012 and June 2019. Early recurrence (ER) and late recurrence (LR) were defined as recurrence at ≤ 2 and > 2 years, respectively, after curative hepatectomy. Nomograms for the prediction of 3- and 5-year OS were established based on multivariate analysis. The areas under time-dependent receiver operating characteristic curves (AUCs) for the nomograms were calculated independently to verify predictive accuracy. The nomograms were internally validated based on 2000 bootstrap resampling of 75% of the original data.Results: In total, 494 patients with HCC who underwent curative hepatectomy met the eligibility criteria. Cox proportional hazard regression analysis identified factors potentially influencing 3- and 5-year OS. Multivariate analysis indicated that patient age, Hong Kong Liver Cancer stage, γ-glutamyl transferase (γ-GGT) level, METAVIR inflammation activity grade, ER and post-recurrence treatment modality were influencing factors for 3-year OS (AUC, 0.891; 95% CI, 0.8364– 0.9447). γ-GGT > 60 U/L, hepatectomy extent, LR and post-recurrence treatment modality were influencing factors for 5-year OS (AUC, 0.864; 95% CI, 0.8041– 0.9237). Calibration plots showed satisfactory concordance between the predicted and actual observation cohorts.Conclusion: We propose new prognostic nomograms for OS prediction with a focus on the differentiation of recurrence timing and post-recurrence management. These nomograms overcome the shortcomings of previous predictive nomograms and significantly improve predictive accuracy.Keywords: hepatocellular carcinoma, hepatectomy, post-recurrence management, overall survival, nomogram |
| first_indexed | 2024-12-22T19:24:00Z |
| format | Article |
| id | doaj.art-06a8401451194763b08f905dd08f69e7 |
| institution | Directory Open Access Journal |
| issn | 2253-5969 |
| language | English |
| last_indexed | 2024-12-22T19:24:00Z |
| publishDate | 2020-10-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Journal of Hepatocellular Carcinoma |
| spelling | doaj.art-06a8401451194763b08f905dd08f69e72022-12-21T18:15:17ZengDove Medical PressJournal of Hepatocellular Carcinoma2253-59692020-10-01Volume 723325658528Prognostic Nomograms for Patients with Hepatocellular Carcinoma After Curative Hepatectomy, with a Focus on Recurrence Timing and Post-Recurrence ManagementXu WLiu FShen XLi RWei Xu,* Fei Liu,* Xianbo Shen,* Ruineng Li Department of Hepatobiliary Surgery, Hunan Provincial People’s Hospital, The First Hospital Affiliated with Hunan Normal University, Changsha, People’s Republic of China*These authors contributed equally to this workCorrespondence: Wei XuDepartment of Hepatobiliary Surgery, Hunan Provincial People’s Hospital, The First Hospital Affiliated with Hunan Normal University, Changsha, People’s Republic of ChinaTel +86 13873159491Fax +86 73182278012Email xuwei0209@163.comBackground: Prognoses of patients with hepatocellular carcinoma (HCC) after curative hepatectomy remain unsatisfactory because of the high incidence of postoperative recurrence. Published predictive systems focus on pre-resection oncological characteristics, ignoring post-recurrence factors.Purpose: This study aimed to develop prognostic nomograms for 3- and 5-year overall survival (OS) of patients with HCC after curative hepatectomy, focusing on potentially influential post-recurrence factors.Patients and Methods: Clinicopathological and postoperative follow-up data were extracted from 494 patients with HCC who underwent curative hepatectomy between January 2012 and June 2019. Early recurrence (ER) and late recurrence (LR) were defined as recurrence at ≤ 2 and > 2 years, respectively, after curative hepatectomy. Nomograms for the prediction of 3- and 5-year OS were established based on multivariate analysis. The areas under time-dependent receiver operating characteristic curves (AUCs) for the nomograms were calculated independently to verify predictive accuracy. The nomograms were internally validated based on 2000 bootstrap resampling of 75% of the original data.Results: In total, 494 patients with HCC who underwent curative hepatectomy met the eligibility criteria. Cox proportional hazard regression analysis identified factors potentially influencing 3- and 5-year OS. Multivariate analysis indicated that patient age, Hong Kong Liver Cancer stage, γ-glutamyl transferase (γ-GGT) level, METAVIR inflammation activity grade, ER and post-recurrence treatment modality were influencing factors for 3-year OS (AUC, 0.891; 95% CI, 0.8364– 0.9447). γ-GGT > 60 U/L, hepatectomy extent, LR and post-recurrence treatment modality were influencing factors for 5-year OS (AUC, 0.864; 95% CI, 0.8041– 0.9237). Calibration plots showed satisfactory concordance between the predicted and actual observation cohorts.Conclusion: We propose new prognostic nomograms for OS prediction with a focus on the differentiation of recurrence timing and post-recurrence management. These nomograms overcome the shortcomings of previous predictive nomograms and significantly improve predictive accuracy.Keywords: hepatocellular carcinoma, hepatectomy, post-recurrence management, overall survival, nomogramhttps://www.dovepress.com/prognostic-nomograms-for-patients-with-hepatocellular-carcinoma-after--peer-reviewed-article-JHChepatocellular carcinomahepatectomypost-recurrence managementoverall survivalnomogram |
| spellingShingle | Xu W Liu F Shen X Li R Prognostic Nomograms for Patients with Hepatocellular Carcinoma After Curative Hepatectomy, with a Focus on Recurrence Timing and Post-Recurrence Management Journal of Hepatocellular Carcinoma hepatocellular carcinoma hepatectomy post-recurrence management overall survival nomogram |
| title | Prognostic Nomograms for Patients with Hepatocellular Carcinoma After Curative Hepatectomy, with a Focus on Recurrence Timing and Post-Recurrence Management |
| title_full | Prognostic Nomograms for Patients with Hepatocellular Carcinoma After Curative Hepatectomy, with a Focus on Recurrence Timing and Post-Recurrence Management |
| title_fullStr | Prognostic Nomograms for Patients with Hepatocellular Carcinoma After Curative Hepatectomy, with a Focus on Recurrence Timing and Post-Recurrence Management |
| title_full_unstemmed | Prognostic Nomograms for Patients with Hepatocellular Carcinoma After Curative Hepatectomy, with a Focus on Recurrence Timing and Post-Recurrence Management |
| title_short | Prognostic Nomograms for Patients with Hepatocellular Carcinoma After Curative Hepatectomy, with a Focus on Recurrence Timing and Post-Recurrence Management |
| title_sort | prognostic nomograms for patients with hepatocellular carcinoma after curative hepatectomy with a focus on recurrence timing and post recurrence management |
| topic | hepatocellular carcinoma hepatectomy post-recurrence management overall survival nomogram |
| url | https://www.dovepress.com/prognostic-nomograms-for-patients-with-hepatocellular-carcinoma-after--peer-reviewed-article-JHC |
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