Establishment of Nomogram model of postoperative recurrence of primary hepatocellular carcinoma with reference to inflammatory cytokines

Objective To establish the Nomogram model of postoperative recurrence of hepatocellular carcinoma ( HCC) by collecting the data on clinical indices and inflammatory cytokines. Methods A total of 314 patients with HCC who were admitted to Wuhan Central Hospital from January 2014 to January 2016 and underwent hepatectomy for the first time were enrolled, and according to follow-up results, these patients were divided into non-recurrence group and recurrence group. General data were collected, and liver function parameters and inflammatory cytokines were measured. The chi-square test was used for comparison of categorical data between two groups, and the Mann-Whitney U test was used for comparison of ranked data between two groups. The receiver operating characteristic ( ROC) curve was used to obtain the optimal cut-off values of continuous data. The multivariate Cox proportional hazards model was used to investigate the independent risk factors for recurrence. The Nomogram model was established according to the results of the multivariate Cox proportional hazards model and was validated by internal data, and the consistency index ( C-index) was calculated. Results The follow-up time ranged from1 month to 40 months, with a median follow-up time of 13 months. Of all patients, 140 had no recurrence, and 174 experienced recurrence. The median recurrence-free survival time was 19 months, and the half-, 1-, and 2-year recurrence-free survival rates were68. 2%, 57. 3%, and 45. 9%, respectively. There were significant differences between the two groups in age, maximum tumor diameter, body mass index ( BMI) , interleukin-2, interleukin-6, interleukin-8, interleukin-17 ( IL-17) , neutrophil-lymphocyte ratio, tumor necrosis factor α ( TNF α) , C-reactive protein, alanine aminotransferase ( ALT) , aspartate aminotransferase, and total bilirubin ( TBil) ( all P < 0. 05) . The Cox proportional hazards model showed that age > 63 years ( hazard ratio[HR]= 2. 391, P < 0. 05) , maximum tumor diameter > 6 cm ( HR = 1. 851, P < 0. 05) , BMI > 27. 17 kg/m2 ( HR = 1. 546, P < 0. 05) , IL-17 > 10. 8 pg/m L ( HR = 1. 556, P <0. 05) , TNF α > 11. 8 ng/L ( HR = 1. 562, P < 0. 05) , ALT > 42 U/L ( HR = 1. 624, P < 0. 05) , and TBil > 15. 6 μmol/L ( HR = 1. 534, P < 0. 05) were independent risk factors for postoperative recurrence in patients with HCC. Validation by internal data showed a C-index of0. 724 ( 95% confidence interval: 0. 668-0. 824) . Conclusion The Nomogram model established in this study can accurately predict the recurrence of HCC patients after first-time hepatectomy, but more clinical studies are needed to confirm this result.