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. 2020 Oct 23;16(16):3210-3220.
doi: 10.7150/ijbs.46896. eCollection 2020.

Postoperative adjuvant TACE-associated nomogram for predicting the prognosis of resectable Hepatocellular Carcinoma with portal vein Tumor Thrombus after Liver Resection

Fuchen Liu  1 , Xinggang Guo  1   2 , Wei Dong  1 , Wenli Zhang  1 , Shuxun Wei  3 , Shutong Zhang  4 , Xiuli Zhu  5 , Weiping Zhou  1 , Jinmin Zhang  6 , Hui Liu  1
Affiliations

Postoperative adjuvant TACE-associated nomogram for predicting the prognosis of resectable Hepatocellular Carcinoma with portal vein Tumor Thrombus after Liver Resection

Fuchen Liu et al. Int J Biol Sci. .

Abstract

Background: To explore the effects of postoperative adjuvant transarterial chemoembolization (PA-TACE) on the prognosis of HCC patients with Portal Vein Tumor Thrombus (PVTT) undergoing resection, and to develop a PA-TACE-related nomogram for predicting survival individually. Patients and Methods: Two hundred and ninety-three consecutive HCC patients with PVTT under R0 hepatectomy were recruited. Forty-seven cases had recurrence within one month after surgery. The remaining 246 cases consisted of 90 PA-TACE and 156 non-PA-TACE cases. COX regression analysis was performed for overall survival (OS) or recurrence-free survival (RFS) of these 246 cases, allowing the derivation of independent factors that were integrated into the nomogram. C-index, calibration curves, and risk stratification were performed to evaluate the performance and discriminative power of the nomograms. Results: In 246 patients without recurrence within one month after surgery, the OS and RFS for the PA-TACE group were significantly better than those for the non-PA-TACE group (P<0.0001, P<0.0001, respectively). After Cox regression analysis of OS or RFS, PA-TACE-related nomogram models were constructed. The C-index of the PA-TACE-related nomogram for OS and RFS was 0.72 and 0.73, respectively. Calibration curves revealed a good agreement between predictions and observations for the nomograms. Based on the nomogram-related risk stratification, Kaplan-Meier curves showed powerful discriminative ability. Conclusions: PA-TACE therapy improved the survival of HCC patients with PVTT undergoing hepatectomy. Accurate nomogram models were developed for predicting the individual survival and recurrence of these patients.

Keywords: HCC with PVTT; Hepatectomy; Nomogram; Postoperative Adjuvant TACE; Prognosis.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exists.

Figures

Figure 1
Figure 1
Flow chart showing screening and grouping of HCC patients with PVTT.
Figure 2
Figure 2
Kaplan-Meier analysis for predicting survival of HCC patients with PVTT with or without postoperative adjuvant TACE. A. Kaplan-Meier analysis for OS, B. Kaplan-Meier analysis for RFS.
Figure 3
Figure 3
Nomograms for survival of HCC patients with PVTT after liver resection. PA-TACE-related nomogram for OS (A) or RFS (B).
Figure 4
Figure 4
Calibration curves of the PA-TACE-related nomogram models for predicting survival in 246 patients with recurrence more than one month after surgical resection. A-C. The calibration curves of the PA-TACE-related nomogram model for predicting OS at 2 years (A), 3 years (B) and 5 years (C); D-F. The calibration curves of the PA-TACE-related nomogram model for predicting RFS at 2 years (D), 3 years (E) and 5 years (F). X-axis represents nomogram-predicted probability of survival; Y-axis represents actual survival.
Figure 5
Figure 5
Kaplan-Meier analysis for survival in HCC patients with PVTT with or without PA-TACE according to the stratification risk groups (high-risk and low-risk) derived from PA-TACE-related nomogram models. A. Kaplan-Meier analysis for OS, B. Kaplan-Meier analysis for RFS.
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