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

https://doi.org/10.1016/j.jvir.2015.04.010Get rights and content

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 cm3); 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.

Section snippets

Study Design

This was a retrospective cohort study undertaken to construct risk-scoring models for patients who receive transarterial chemoembolization secondary to unresectable HCC, in whom the derivation and validation cohorts from the gastroenterology department of a single tertiary referral center were temporarily separated.

Derivation and Validation Sets

Consecutive data were collected for patients with a new diagnosis of HCC who were treated with transarterial chemoembolization as initial therapy at a single center between January

Baseline Characteristics of Enrolled Patients

The demographic and clinical parameters of the derivation and validation sets are provided in Table 1. The mean age of the 1,181 patients was 55.9 years (standard deviation [SD], 10.1 y). Of the patients, 981 (83.1%) were men, 953 (80.7%) had liver cirrhosis, 931 (78.8%) were in Child-Pugh class A, and 927 (78.5%) had nodular-type tumors. Median tumor volume was 39.0 cm3, mean MELD score was 9.0 (SD, 2.5), and median serum AFP was 99.7 ng/mL. At the time of diagnosis, 280 (23.7%) patients had

Discussion

In the present study, we developed nomograms for predicting OS and PFS in patients undergoing transarterial chemoembolization. Because of the heterogeneity of the patients included in the various studies, the clinical factors described to be of prognostic importance in previous research were quite diverse (9, 10, 11, 12, 13, 14), and their predictive value had yet to be firmly established. In the present study, seven clinically and statistically important variables were selected and

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    • Y.H. and S.H. contributed equally to this article.

    None of the authors have identified a conflict of interest.

    Appendix A and Appendix B are available online at www.jvir.org.

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    Copyright © 2015 SIR. Published by Elsevier Inc. All rights reserved.