Nomogram based on tumor burden score for prediction of prognosis of patients with hepatocellular carcinoma before hepatectomy

Qianru Xiao¹Zhengqing Lei¹Anfeng Si²Xuewu Tang¹Facai Yang¹Weihu Ma¹Cheng Chi¹Qiushi Yu¹Yigang He¹Haolan Tang¹Tianhang Su¹Fangyuan Hu¹Jianning Lu¹Youheng Yu¹Ziqi Liu¹Pinghua Yang³Zhangjun Cheng^1*

• ¹Department of Hepatobiliary and Pancreatic Surgery, Zhongda Hospital, Southeast University, Nanjing, Jiangsu Province, China
• ²Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
• ³Department of Hepatic Surgery IV, the Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China

Purpose: To develop nomogram models predicting the prognosis for patients with hepatocellular carcinoma (HCC) before hepatectomy.Methods: Patients treated at the Eastern Hepatobiliary Surgery Hospital and Zhongda Hospital, Southeast University, from January 2012 to July 2014, were retrospectively enrolled. Prediction models for overall survival (OS) and recurrence-free survival (RFS) were constructed.Results: A total of 1117 patients with HCC were enrolled in this study, and were divided into a training cohort (n=838) and a validation cohort (n=279). A prediction model for OS in the training cohort (OS-nomo, C-index=0.71), including alpha-fetoprotein (AFP), estimated hepatectomy extent, and tumor burden score (TBS) as independent factors (all P<0.05), was constructed. For clinical application, we stratified all patients into three distinct risk groups: low-, medium-, and high-risk group for OS, based on total points (TPs). Patients undergoing major hepatectomy, with AFP>20 ng/mL and high level of TBS had the worst OS.Conclusion: When selecting patients with HCC for hepatectomy, factors including sex, CPS, AFP level, estimated hepatectomy extent, and TBS should be carefully considered. OS-nomo model could serve as important tool for personalized survival prediction.