Nomograms for Predicting Outcomes after Chemoembolization in Patients with Nonmetastatic Hepatocellular Carcinoma.

Abstract

PURPOSE:

To construct prognostic nomograms capable of estimating individual probabilities of tumor progression and overall survival (OS) at specific time points during serial transarterial chemoembolization for hepatocellular carcinoma (HCC).

MATERIALS AND METHODS:

The study included 1,181 consecutive patients with nonmetastatic HCC undergoing repeated transarterial chemoembolization at a single tertiary referral center. Patients were assigned to 2 cohorts according to the first transarterial chemoembolization date: derivation (2004-2006; n = 854) and validation (2007; n = 327) sets. Multivariate Cox proportional hazards models were developed based on covariates derived before transarterial chemoembolization and assessed for their association with 5-year OS and 3-year progression-free survival (PFS). The accuracy of the models was internally and externally validated.

RESULTS:

The 5-year OS of the derivation set was 25.4%, and 3-year PFS was 20.8%. Nomograms for OS and PFS were built into the derivation set incorporating the following factors: log [tumor volume] calculated as 4/3 × 3.14 × (maximum radius of tumor in cm(3)); tumor number; tumor type (nodular or infiltrative); Child-Pugh class (A or B); (model for end-stage liver disease score/10)(-2); log [α-fetoprotein]; and portal vein invasion. The models had good discrimination and calibration abilities with C-indexes of 0.80 (5-y survival) and 0.77 (3-y progression). The results of external validation confirmed that these models performed well in terms of discrimination and goodness-of-fit (C-indexes 0.77 for 5-y survival and 0.73 for 3-y progression).

CONCLUSION:

Nomograms quantifying the survival and progression outcomes in patients treated with transarterial chemoembolization are useful clinical aids in providing personalized care.

• Authors: Yeonjung Ha, Seungbong Han, Ju Hyun Shim, Gi-Young Ko, Hyun-Ki Yoon, Kyu-Bo Sung, Danbi Lee, Kang Mo Kim, Young-Suk Lim, Young-Hwa Chung, Yung Sang Lee, Han Chu Lee
• Journal: Journal of vascular and interventional radiology : JVIR (J Vasc Interv Radiol) Vol. 26 Issue 8 Pg. 1093-1101.e1 (Aug 2015) ISSN: 1535-7732 [Electronic] United States
• PMID: 26077020 (Publication Type: Journal Article)
• Copyright: Copyright © 2015 SIR. Published by Elsevier Inc. All rights reserved.

Topics

• Age Distribution
• Carcinoma, Hepatocellular (diagnosis, mortality, therapy)
• Chemoembolization, Therapeutic (mortality)
• Cohort Studies
• Disease-Free Survival
• Female
• Humans
• Liver Neoplasms (diagnosis, mortality, therapy)
• Longitudinal Studies
• Male
• Middle Aged
• Nomograms
• Outcome Assessment, Health Care (methods, statistics & numerical data)
• Prevalence
• Prognosis
• Proportional Hazards Models
• Reproducibility of Results
• Republic of Korea (epidemiology)
• Retrospective Studies
• Risk Factors
• Sensitivity and Specificity
• Sex Distribution
• Survival Rate
• Treatment Outcome