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Randomized Controlled Trial
. 2022 Sep 13;22(1):339.
doi: 10.1186/s12893-022-01789-4.

Novel postoperative nomograms for predicting individual prognoses of hepatitis B-related hepatocellular carcinoma with cirrhosis

Liangliang Xu  1 , Fuzhen Dai  2 , Peng Wang  1 , Lian Li  1 , Ming Zhang  1 , Mingqing Xu  3
Affiliations
Randomized Controlled Trial

Novel postoperative nomograms for predicting individual prognoses of hepatitis B-related hepatocellular carcinoma with cirrhosis

Liangliang Xu et al. BMC Surg. .

Abstract

Background: Liver cirrhosis is a well-known risk factor for carcinogenesis of hepatocellular carcinoma (HCC). The aim of the present study was to construct individual prognostic models for HCC with cirrhosis.

Methods: The clinical differences between HCC patients with and without cirrhosis were compared using a large cohort of 1003 cases. The patients with cirrhosis were randomly divided into a training cohort and a validation cohort in a ratio of 2:1. Univariate and multivariate analyses were performed to reveal the independent risk factors for recurrence-free survival (RFS) and overall survival (OS) in HCC patients with cirrhosis. These factors were subsequently used to construct nomograms.

Results: Multivariate analyses revealed that five clinical variables (hepatitis B e antigen (HBeAg) positivity, alpha-fetoprotein (AFP) level, tumour diameter, microvascular invasion (MVI), and satellite lesions) and seven variables (HBeAg positivity, AFP level, tumour diameter, MVI, satellite lesions, gamma-glutamyl transpeptidase level, and histological differentiation) were significantly associated with RFS and OS, respectively. The C-indices of the nomograms for RFS and OS were 0.739 (P < 0.001) and 0.789 (P < 0.001), respectively, in the training cohort, and 0.752 (P < 0.001) and 0.813 (P < 0.001), respectively, in the validation cohort. The C-indices of the nomograms were significantly higher than those of conventional staging systems (P < 0.001). The calibration plots showed optimal consistence between the nomogram-predicted and observed prognoses.

Conclusions: The nomograms developed in the present study showed good performance in predicting the prognoses of HCC patients with hepatitis B virus-associated cirrhosis.

Keywords: Cirrhosis; Hepatitis B virus; Hepatocellular carcinoma; Nomogram; Prognosis.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The fibrosis extent of included patients with HCC was evaluated by Ishak scoring system
Fig. 2
Fig. 2
Nomograms for predicting recurrence-free survival (RFS) (a) and overall survival (OS) (b) in cirrhotic patients with HCC who underwent curative liver resection. HBeAg hepatitis B e antigen, AFP alpha-fetoprotein, MVI microvascular invasion, GGT gamma-glutamyl transpeptidase
Fig. 3
Fig. 3
Calibration curves for predicting Recurrence-free survival (RFS) and overall survival (OS) using the nomograms. a and b 3 and 5-year RFS in the training cohort. c and d 3 and 5-year OS in the training cohort. e and f 3 and 5-year RFS in the validation cohort. g and h 3 and 5-year OS in the validation cohort
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