Establishment of a prognosis-related predictive model for hepatocellular carcinoma patients with macrovascular invasion treated with transcatheter arterial chemoembolization combined with intensity modulated radiotherapy

Abstract

Background: So far, there are still few studies on the prognostic factors of hepatocellular carcinoma (HCC) patients with macrovascular invasion (MVI) treated with transcatheter arterial chemoembolization (TACE) combined with intensity modulated radiotherapy (IMRT), and no relevant model has been established to predict the prognosis of such patients. Thus, the purpose of this study was to determine the prognostic factors of HCC patients with MVI after treatment with TACE combined with IMRT, and to establish a nomogram model for forecasting 1-, 3-, 5-year overall survival (OS) of the patients.

Methods: HCC patients with MVI who were diagnosed and treated at Department of Gastroenterology, 3201 Hospital between January 2010 and December 2020 were enrolled in this study according to the inclusion and exclusion criteria. The risk factors linked to patient OS were determined by performing Cox regression analysis. The nomogram for predicting 1-, 3-, 5-year OS in HCC patients with MVI was stablished and validated based on the results of the Cox regression analysis.

Results: In total, 118 patients were included in the current study. The medium follow-up time was 46 months (range, 29-71 months). Univariate Cox regression analysis revealed that tumor diameter, treatment frequency of TACE, IMRT dose, Child-Pugh grade, liver cirrhosis and alpha fetoprotein (AFP) level were significantly related to the OS of the patients. Further multivariate Cox regression analysis showed that treatment frequency of TACE and Child-Pugh grade, liver cirrhosis and AFP level were the independent prognostic factors of the OS in patients who were treated with TACE combined with IMRT. The nomogram we constructed using the above independent risk factors exhibited good ability for predicting 1-, 3-, 5-year OS of the patients. The concordance-index of the nomogram was 0.727, indicating the nomogram had a good discrimination.

Conclusions: Treatment frequency of TACE and Child-Pugh grade, liver cirrhosis and AFP level were independent predictors of OS in HCC patients with MVI after TACE combined with IMRT treatment. The nomogram that we developed using these predictors provided a convenient tool to predict the survival probability in HCC patients with MVI.

Keywords: Hepatocellular carcinoma (HCC); intensity modulated radiotherapy (IMRT); macrovascular invasion (MVI); nomogram; transcatheter arterial chemoembolization (TACE).

Figure 1

The nomogram for predicting 1-, 3-, 5-year OS of HCC patients with MVI after treatment TACE combined with IMRT. TACE, transcatheter arterial chemoembolization; AFP, alpha fetoprotein; OS, overall survival; HCC, hepatocellular carcinoma; MVI, macrovascular invasion; IMRT, intensity modulated radiotherapy.

Figure 2

Bootstrap calibration curve of the nomogram for predicting 1-, 3-, 5-year OS of HCC patients with MVI after treatment TACE combined with IMRT. The X-axis represents the predicted probability, and the Y-axis represents the actual probability. The gray line represents the ideal value, and the black line represents the predicted value. It is showed that the trend of the predicted value is consistent with the true value, indicating the good calibration effect of the nomogram. OS, overall survival; HCC, hepatocellular carcinoma; MVI, macrovascular invasion; TACE, transcatheter arterial chemoembolization; IMRT, intensity modulated radiotherapy.