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. 2022 Dec 26;10(36):13250-13263.
doi: 10.12998/wjcc.v10.i36.13250.

Prognostic factors for disease-free survival in postoperative patients with hepatocellular carcinoma and construction of a nomogram model

Pan-Quan Luo  1 , Zheng-Hui Ye  1 , Li-Xiang Zhang  1 , En-Dong Song  1 , Zhi-Jian Wei  1 , A-Man Xu  1 , Zhen Lu  2   3
Affiliations

Prognostic factors for disease-free survival in postoperative patients with hepatocellular carcinoma and construction of a nomogram model

Pan-Quan Luo et al. World J Clin Cases. .

Abstract

Background: Hepatocellular carcinoma (HCC) is the most common type of liver cancer and has a high risk of invasion and metastasis along with a poor prognosis.

Aim: To investigate the independent predictive markers for disease-free survival (DFS) in patients with HCC and establish a trustworthy nomogram.

Methods: In this study, 445 patients who were hospitalized in The First Affiliated Hospital of Anhui Medical College between December 2009 and December 2014 were retrospectively examined. The survival curve was plotted using the Kaplan-Meier method and survival was determined using the log-rank test. To identify the prognostic variables, multivariate Cox regression analyses were carried out. To predict the DFS in patients with HCC, a nomogram was created. C-indices and receiver operator characteristic curves were used to evaluate the nomogram's performance. Decision curve analysis (DCA) was used to evaluate the clinical application value of the nomogram.

Results: Longer DFS was observed in patients with the following characteristics: elderly, I-II stage, and no history of hepatitis B. The calibration curve showed that this nomogram was reliable and had a higher area under the curve value than the tumor node metastasis (TNM) stage. Moreover, the DCA curve revealed that the nomogram had good clinical applicability in predicting 3- and 5-year DFS in HCC patients after surgery.

Conclusion: Age, TNM stage, and history of hepatitis B infection were independent factors for DFS in HCC patients, and a novel nomogram for DFS of HCC patients was created and validated.

Keywords: Disease-free survival; Hepatocellular carcinoma; Nomogram; Prognosis.

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Conflict of interest statement

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Figures

Figure 1
Figure 1
Kaplan-Meier curve of disease-free survival according to different subgroups. A: Age groups; B: Stage groups; C: History of hepatitis B groups.
Figure 2
Figure 2
Kaplan-Meier curves of disease-free survival in different age groups based on tumor node metastasis stage. A: Kaplan-Meier curves of disease-free survival (DFS) in different age groups based on I-II stage; B: Kaplan-Meier curves of DFS in different age groups based on III-IV stage.
Figure 3
Figure 3
Kaplan-Meier curves of disease-free survival in different stage groups based on age. A: Kaplan-Meier curves of disease-free survival (DFS) in different stage groups based on age ≥ 70 years; B: Kaplan-Meier curves of DFS in different stage groups based on age < 70 years.
Figure 4
Figure 4
Kaplan-Meier curves of disease-free survival in patients with a different history of hepatitis B based on tumor node metastasis stage. A: Kaplan-Meier curves of disease-free survival (DFS) in groups with a different history of hepatitis B based on I-II stage; B: Kaplan-Meier curves of DFS in groups with a different history of hepatitis B based on III-IV stage.
Figure 5
Figure 5
Nomogram for predicting disease-free survival of hepatocellular carcinoma patients after curative resection. TNM: Tumor node metastasis.
Figure 6
Figure 6
Calibration curves of the prognostic nomogram for disease-free survival in hepatocellular carcinoma patients. A: 3-year calibration curves of the prognostic nomogram for disease-free survival (DFS) in hepatocellular carcinoma (HCC) patients; B: 5-year calibration curves of the prognostic nomogram for DFS in HCC patients.
Figure 7
Figure 7
The receiver operator characteristic curves of the prognostic nomogram and tumor node metastasis stage. TNM: Tumor node metastasis.
Figure 8
Figure 8
The decision curve analysis curve of the prognostic nomogram for disease-free survival in hepatocellular carcinoma patients. A: 3-year decision curve analysis (DCA) curves of the prognostic nomogram for disease-free survival (DFS) in hepatocellular carcinoma (HCC) patients; B: 5-year DCA curves of the prognostic nomogram for DFS in HCC patients.
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