Nomogram for predicting overall survival in patients with large (>5 cm) hepatocellular carcinoma based on real-world practice

Abstract

Background/aim: Patients with large (>5 cm) hepatocellular carcinoma (HCC) have limited treatment options, thus necessitating the identification of prognostic factors and the development of predictive tools. This study aimed to identify prognostic factors and to construct a nomogram to predict survival outcomes in patients with large HCC.

Methods: A cohort of 438 patients, who were diagnosed with large HCC at a tertiary hospital between 2015 and 2018, was analyzed. Cox proportional hazards models were used to identify key prognosticators of overall survival (OS), and an independent set of prognostic factors was used to develop a nomogram. The discrimination and calibration abilities of the nomogram were assessed and internal validation was performed using cross-validation and bootstrapping methods.

Results: During a median follow-up of 9.3 months, the median OS was 9.9 months, and the 1-year OS rate was 43.9%. Multivariable Cox regression analysis revealed that performance status, modified albumin-bilirubin grade, tumor size, extent of portal vein tumor thrombosis, and initial treatment significantly affected OS. The newly developed nomogram incorporating these variables demonstrated favorable accuracy (Harrell's concordance index, 0.807).

Conclusions: The newly developed nomogram facilitated the estimation of individual survival outcomes in patients with large HCC, providing an acceptable level of accuracy.

Keywords: Carcinoma, hepatocellular; Nomograms; Prognosis.

Figure 1.

Progression-free survival (PFS) and overall survival (OS) outcomes for the entire patient cohort.

Figure 2.

Nomogram for predicting 1-, and 2-year survival rates in patients with large hepatocellular carcinoma. The nomogram summed the points identified on the scale for each variable. The total points projected on the bottom scale indicate the probabilities of survival. ECOG PS, Eastern Cooperative Oncology Group performance status; mALBI, modified albumin-bilirubin index; AFP, alpha fetoprotein; BSC, best supportive care; Tx, treatment; BCLC, Barcelona Clinic Liver Cancer.

Figure 3.

Calibration plots of the developed nomogram for internal validation. (A) One-year survival probability, (B) 2-year survival probability.

Figure 4.

Kaplan–Meier survival curves stratified according to the (A) modified Union for International Cancer Control (mUICC) system, (B) Barcelona Clinic Liver Cancer (BCLC) system, (C) the new nomogram for all patients, and (D) the new nomogram for BCLC stage C patients.