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Nomograms for Pre-operative and Post-operative Prediction of Long-Term Survival of Patients Who Underwent Repeat Hepatectomy for Recurrent Hepatocellular Carcinoma

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Repeat hepatectomy (re-hepatectomy) is an effective treatment for patients with intrahepatic recurrence following liver resection for hepatocellular carcinoma (HCC).

Objective

This study aimed to develop nomograms for predicting prognosis after re-hepatectomy.

Methods

The data of 635 patients who underwent re-hepatectomy for recurrent HCC at the Eastern Hepatobiliary Surgery Hospital between 2004 and 2010 were prospectively collected. Multivariable Cox regression analyses based on data obtained before and after re-hepatectomy were performed to select independent predictors of recurrence to death survival (RTDS) which were incorporated into the pre- or post-re-hepatectomy nomograms. Discrimination and calibration of the nomograms were measured using the concordance index (C-index), Kaplan–Meier curves, and calibration plots.

Results

The 1-, 3- and 5-year overall survival rates were 96.9, 74.8, and 47.8 %, respectively, and the corresponding RTDS rates were 75.8, 45.7, and 37.6 %, respectively. Tumor size and number at the initial and recurrent stages, time to recurrence from the initial hepatectomy, hepatitis B virus deoxyribonucleic acid level and microvascular invasion were selected into the two nomograms. The C-indexes for predicting RTDS were 0.72 [95 % confidence interval (CI) 0.70–0.74] and 0.77 (95 % CI 0.74–0.80) for the pre- or post-re-hepatectomy nomograms, respectively. The calibration curves for the probability of 5-year RTDS after re-hepatectomy showed optimal agreement between the prediction shown in the nomograms and the actual observations. Both nomograms were able to accurately stratify patients into four distinct incremental prognostic subgroups.

Conclusion

The proposed nomograms have shown accurate RTDS prediction for patients with intrahepatic recurrent HCC.

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Funding

This study was supported by the State Key Project on Infectious Diseases of China (2012ZX10002–016, to Feng Shen), Shanghai Municipal Science and Technology Project (12431900803, to Feng Shen), and the Natural Science Foundation and Medical Development of Shanghai (12ZR1439700, 134119a7100, to Jun Li).

Disclosure

No potential conflicts of interest were disclosed.

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Author notes

    Authors and Affiliations

    1. Department of Hepatic Surgery, The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China

      Qifei Zou MD, Jun Li MD, Zhenlin Yan MD, Kui Wang MD, Lehua Shi MD, Wan Yee Lau MD, Mengchao Wu MD & Feng Shen MD

    2. Department of Clinical Database, The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China

      Dong Wu MD, Xuying Wan MD & Lehua Shi MD

    3. Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China

      Wan Yee Lau MD

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    1. Qifei Zou MD
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    2. Jun Li MD
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    Corresponding author

    Correspondence to Feng Shen MD.

    Additional information

    Qifei Zou and Jun Li have been contributed equally in this work.

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    Zou, Q., Li, J., Wu, D. et al. Nomograms for Pre-operative and Post-operative Prediction of Long-Term Survival of Patients Who Underwent Repeat Hepatectomy for Recurrent Hepatocellular Carcinoma. Ann Surg Oncol 23, 2618–2626 (2016). https://doi.org/10.1245/s10434-016-5136-0

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    • DOI: https://doi.org/10.1245/s10434-016-5136-0

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