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Title: Prognostic Nomograms Stratify Survival of Patients with Hepatocellular Carcinoma Without Portal Vein Tumor Thrombosis After Curative Resection.
Author: Fu YP, Yi Y, Huang JL, Jing CY, Sun J, Ni XC, Lu ZF, Cao Y, Zhou J, Fan J, Qiu SJ.
Journal: Oncologist; 2017 May; 22(5):561-569. PubMed ID: 28438885.
Abstract:
BACKGROUND: The prognosis of patients with hepatocellular carcinoma (HCC) without portal vein tumor thrombosis (PVTT) after curative resection is at variance. We identified the risk factors of poor postoperative prognosis and consequently developed prognostic nomograms generating individual risk of death and recurrence for this subgroup of patients with HCC. METHODS: The risk factors were identified and nomograms were developed based on a retrospective study of 734 patients in the primary cohort who underwent curative resection for HCC from 2010 to 2012. The predictive accuracy and discriminative ability of the nomograms were determined by concordance index (C-index) and calibration curve and compared with traditional staging systems of HCC. The results were validated in an independent cohort of 349 patients operated at the same institution in 2007. RESULTS: All of the independent factors for survival in multivariate analysis in the primary cohort were selected into the nomograms. The calibration curve for probability of survival showed good agreement between prediction by nomograms and actual observation. The C-indices of the nomograms for predicting overall survival and recurrence-free survival were 0.755 (95% confidence interval [CI], 0.752-0.758) and 0.665 (95% CI, 0.662-0.668), respectively, which were statistically higher than the C-indices of other HCC prognostic models. The results were further confirmed in the validation cohort. CONCLUSION: The proposed nomograms resulted in more accurate prognostic prediction for patients with HCC without PVTT after curative resection. The Oncologist 2017;22:561-569 IMPLICATIONS FOR PRACTICE: Hepatocellular carcinoma (HCC) poses a great therapeutic challenge due to the poor prognosis in patients underwent surgical resection. The portal vein tumor thrombosis (PVTT) as a robust risk factor for survival has been routinely integrated to staging systems. Nonetheless, the prognosis stratification for patients without PVTT was neglected to some extent. Herein, independent risk factors of OS and RFS in HCC patients without PVTT were reconfirmed. A predictive nomogram was constructed on these risk factors and was demonstrated to be a more accurate predictive model in HCC patients without PVTT, compared with the traditional staging systems. 摘要背景. 业内对于无PVTT的HCC患者行根治性切除术后的预后仍有争议。我们已识别出这一HCC患者亚组术后预后不良的风险因素, 并据此开发了可生成各种死亡和复发风险的预后列线图。方法. 对2010‐2012年间行根治性切除术治疗HCC的734例患者（主要队列）进行了一项回顾性研究, 在此基础之上识别风险因素并开发列线图。通过一致性指数（C指数）和校准曲线确定列线图的预测准确度和判别能力, 并与传统HCC分期系统进行比较。在一个独立队列, 即于2007年在同一机构接受手术的349例患者中验证所得结果。结果. 将主要队列多变量分析中生存期的所有独立风险因素纳入列线图。在生存概率校准曲线中, 列线图预测值与实际观测值的吻合度较好。列线图预测总生存期和无复发生存期时的C指数分别为0.755[95%置信区间（CI）：0.752‐0.758]和0.665（95% CI：0662‐0.668）, 显著高于其他HCC预后模型的C指数。该结果在验证队列中得到了进一步确认。结论. 本研究构建的列线图可以更准确地预测无PVTT的HCC患者行根治性切除术后的预后。The Oncologist 2017;22:561–569 对临床实践的提示：肝细胞癌（HCC）患者行切除手术后的预后较差, 从而给治疗带来了严峻挑战。门静脉癌栓（PVTT）是生存期的稳健风险因素之一, 已在常规实践中将其纳入分期系统。尽管如此, 我们仍在一定程度上忽视了无PVTT患者的预后分层。因此, 本研究在无PVTT的HCC患者中再次确认了总生存期（OS）和无复发生存期（RFS）的独立风险因素。针对上述风险因素构建了预测列线图, 结果证明在无PVTT的HCC患者中, 以该列线图作为预测模型时的准确度高于传统分期系统。

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