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ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 38 Issue 1
Jan.  2022
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Article Navigation >  Journal of Clinical Hepatology  > 2022  >  38(1): 110-116

Establishment of a nomogram for survival rate after liver resection for primary small hepatocellular carcinoma based on SEER data and external validation

DOI: 10.3969/j.issn.1001-5256.2022.01.017

  • Second Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, China

Research funding:

Sichuan Science and Technology Program Project (2018JY0489);

Sichuan Education Department Scientific Research Project (18ZB0217);

Sichuan Health Care Commission Popular Application Project (20PJYY2695);

North Sichuan Medical College Scientific Research Project (CBY18-A-YB37)

  • Received Date: 2021-06-09
  • Accepted Date: 2021-06-29
  • Published Date: 2022-01-20
    Abstract
  •   Objective  To establish a nomogram for overall survival rate after liver resection for primary small hepatocellular carcinoma based on SEER data and external validation of Chinese data.  Methods  The data of 1809 patients, registered in National Cancer Institute SEER database in 2004-2015, who underwent hepatectomy for primary small hepatocellular carcinoma were extracted as modeling group, and 158 patients with small hepatocellular carcinoma who underwent hepatectomy in Affiliated Hospital of North Sichuan Medical College from 2010 to 2017 were collected as validation group. The univariate Cox risk regression analysis, lasso regression analysis, and multivariate Cox hazard regression analysis were used to investigate the influencing factors for OS after hepatectomy in patients with small hepatocellular carcinoma. A nomogram was established based on the independent influencing factors for OS, and index of concordance (C-index), calibration curves, and receiver operating characteristic (ROC) curve were used to analyze the predictive ability of the nomogram. The Kaplan-Meier survival analysis and the log-rank test were used to investigate the difference in survival between the high- and low-risk groups.  Results  The multivariate Cox hazard regression analysis showed that sex (hazard ratio [HR]=1.22, 95% confidence interval [CI]: 1.05-1.41, P=0.010), Seer stage (HR=1.51, 95%CI: 1.23-1.85, P < 0.001; HR=10.31, 95%CI: 2.53-42.04, P=0.001), tumor diameter (HR=1.22, 95%CI: 1.06-1.39, P=0.004), vascular invasion or metastasis (HR=1.43, 95%CI: 1.24-1.65, P < 0.001), and alpha-fetoprotein (HR=1.33, 95%CI: 1.16-1.54, P < 0.001) were independent risk factors for OS after hepatectomy for small hepatocellular carcinoma. The modeling group had a C-index of 0.621, and its area under the ROC curve at 1, 2, and 3 years was 0.666(95%CI 0.628-0.704), 0.678(95%CI 0.647-0.708), and 0.663(95%CI: 0.635-0.690), respectively; the validation group had a C-index of 0.718, and its area under the ROC curve at 1, 2, and 3 years was 0.695(95%CI: 0.593-0.797), 0.781(95%CI: 0.706-0.856), and 0.759(95%CI 0.669-0.848), respectively. Risk stratification was performed based on the nomogram, and the Kaplan-Meier survival analysis showed that for both the modeling group and the validation group, the low-risk group had a significantly better prognosis than the high-risk group (P < 0.01).  Conclusion  The model established for survival rate after liver resection for primary small hepatocellular carcinoma can predict the 1-, 2-, and 3-year OS rates and can thus be used in clinical practice in China.

     

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