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Novel Prognostic Nomograms Based on Inflammation-Related Markers for Patients with Hepatocellular Carcinoma Underwent Hepatectomy

Cancer Research and Treatment 2019년 51권 4호 p.1464 ~ 1478
 ( Wang Yifei ) - Sun Yat-Sen University First Affiliated Hospital Department of Liver Surgery

 ( Sun Kaiyu ) - Sun Yat-Sen University First Affiliated Hospital Department of Gastrointestinal Surgery
 ( Shen Jingxian ) - Sun Yat-Sen University Cancer Center Department of Medical Imaging
 ( Li Bin ) - Sun Yat-Sen University First Affiliated Hospital Clinical Trials Unit
 ( Kuang Ming ) - Sun Yat-Sen University First Affiliated Hospital Department of Liver Surgery
 ( Cao Qinghua ) - Sun Yat-Sen University First Affiliated Hospital Department of Pathology
 ( Peng Sui ) - Sun Yat-Sen University First Affiliated Hospital Clinical Trials Unit

Abstract


Purpose: Hepatocellular carcinoma (HCC) is an aggressive disease with high recurrence rate. However, current staging systems were lack of predictive capacity for HCC recurrence. We aimed to develop prognostic nomograms based on inflammation-related markers for HCC patients underwent hepatectomy.

Materials and Methods: We recruited 889 surgically treated patients from two medical centers. Independent prognostic factors were identified by cox regression analyses. Nomograms for recurrence-free survival (RFS) and overall survival (OS) were established, and validated internally and externally. The performance, discrimination, and calibration of nomograms were assessed, and compared with existed staging systems.

Results: Neutrophil to lymphocyte ratio (NLR) and gamma-glutamyl transpeptidase to platelet ratio (GPR) were the two inflammation-related factor that independently correlated with survival. NLR, GPR, international normalized ratio (INR), microvascular invasion, satellite lesions, tumour number, tumour diameter, and macrovascular invasion were used to construct nomogram for RFS while GPR, total bilirubin, INR, α-fetoprotein, microvascular invasion, satellite lesions, tumour diameter, and macrovascular invasion were for OS. In the training cohort, the C-index of nomogram was 0.701 (95% confidence interval [CI], 0.669 to 0.732) for RFS and 0.761 (95% CI, 0.728 to 0.795) for OS. These results received both internal and external validation with C-index of 0.701 (95% CI, 0.647 to 0.755) and 0.707 (95% CI, 0.657 to 0.756) for RFS, and 0.706 (95% CI, 0.640 to 0.772) and 0.708 (95% CI, 0.646 to 0.771) for OS, respectively. The nomograms showed superior accuracy to conventional staging systems (p<0.001).

Conclusion: The nomograms based on inflammation-related markers are of high efficacy in predicting survival of HCC patients after hepatectomy, which will be valuable in guiding postoperative interventions and follow-ups.

키워드

Hepatocellular carcinoma; Inflammation; Resection; Survival; Nomograms
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