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Validated nomogram for the prediction of disease-free survival after hepatectomy for hepatocellular carcinoma within the Milan criteria: individualizing a surveillance strategy

  • Ka Wing Ma
  • Wong Hoi She
  • Tan To Cheung
  • Albert Chi Yan Chan
  • Wing Chiu Dai
  • James Yan Yue Fung
  • Chung Mau Lo
  • Kenneth Siu Ho Chok
Original Article
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Abstract

Objective

We sought to develop a nomogram for the prediction of tumor recurrence after resection of hepatocellular carcinoma (HCC) within the Milan criteria.

Method

Consecutive HCC patients admitted for hepatectomy between 1994 and 2014 were enrolled in this study. Patients were excluded if they had recurrent HCC or tumors beyond the Milan criteria. Patients were randomized and assigned to the derivation and validation sets in a 1:1 ratio. Independent factors for disease-free survival were identified using the Cox regression model. A nomogram was derived and validated with the receiver-operating characteristic (ROC) and calibration curves.

Results

There were 617 eligible patients included in the analysis. The median age was 59 years, 481 were male, and 87.8% of the patients were hepatitis B virus carriers. The median follow-up was 68.7 months. The 5-year overall survival rate was 73.3% and HCC recurrence was detected in 55% of the patients. In the derivation set, a nomogram was constructed based on the seven independent factors for disease-free survival: age, alpha-fetoprotein, preoperative prothrombin time, magnitude of hepatectomy, postoperative complication, number of tumor nodules, and presence of microvascular invasion. A satisfactory discrimination ability was observed in both the derivation and validation sets (c-stat 0.672 and 0.665, respectively). The calibration plot yielded agreement between the predicted and observed outcomes, using the derived nomogram.

Conclusion

A validated nomogram quantifies the risk of recurrence after hepatectomy for HCC within the Milan criteria, and assists with the planning of individual postoperative surveillance protocols.

Keywords

Hepatocellullar carconoma Recurrence Prediction Nomogram 

Abbreviations

ABLI

Albumin–bilirubin index

AFP

Alpha-fetal protein

AFP_Ln

Natural log of AFP

ALT

Alanine transferase

ALPPS

Associating liver partition with portal vein ligation for staged hepatectomy

AST

Aspartate transaminase

AUC

Area under curve

CTP

Child–Turcotte–Pugh

CRS

Clinical risk score

CUSA

Cavitron ultrasonic surgical aspirator

ESLV

Estimated standard liver volume

HCC

Hepatocellular carcinoma

HKU

The University of Hong Kong

IBS

Inflammation-based score

ICG

Indocyanine green

IOUS

Intraoperative ultrasonography

INR

International normalization ratio

LVI

Lymphovascular invasion

PIVKA-II

Protein-induced vitamin K antagonist II

ROC

Receiver-operating characteristic

TACE

Trans-arterial chemoembolization

Notes

Acknowledgements

We thank Mr. Yuen Ho Kam, Kim Bsc (Comp&stat) for data management and analysis.

Funding

This study received no support in the form of equipment, drugs, grants or funding.

Compliance with ethical standards

Conflict of interest

We have no conflicts of interest to declare in relation to this study.

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Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Ka Wing Ma
    • 1
  • Wong Hoi She
    • 1
  • Tan To Cheung
    • 1
  • Albert Chi Yan Chan
    • 1
  • Wing Chiu Dai
    • 1
  • James Yan Yue Fung
    • 2
  • Chung Mau Lo
    • 1
  • Kenneth Siu Ho Chok
    • 1
  1. 1.Divisions of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Department of Surgery, The University of Hong KongQueen Mary HospitalHong KongChina
  2. 2.Department of MedicineThe University of Hong KongHong KongChina

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