Nomograms based on clinicopathological factors and inflammatory indicators for prediction of early and late recurrence of hepatocellular carcinoma after surgical resection for patients with chronic hepatitis B

Tianxing Dai; Mingbin Deng; Linsen Ye; Guozhen Lin; Rongqiang Liu; Yinan Deng; Rong Li; Wei Liu; Hua Li; Yang Yang; Guihua Chen; Guoying Wang

doi:10.21037/atm-20-1353

Nomograms based on clinicopathological factors and inflammatory indicators for prediction of early and late recurrence of hepatocellular carcinoma after surgical resection for patients with chronic hepatitis B

Ann Transl Med. 2021 Jan;9(1):12. doi: 10.21037/atm-20-1353.

Authors

Tianxing Dai¹, Mingbin Deng¹, Linsen Ye¹, Guozhen Lin¹, Rongqiang Liu¹, Yinan Deng^{1

2}, Rong Li³, Wei Liu³, Hua Li^{1

2}, Yang Yang^{1

2}, Guihua Chen^{1

2}, Guoying Wang^{1

2}

Affiliations

¹ Department of Hepatic Surgery and Liver Transplant Program, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
² Organ Transplantation Institute of Sun Yat-Sen University, Guangzhou, China.
³ Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.

Abstract

Background: Few studies have focused on the prognostic values of inflammation-related factors for different phases of recurrence in hepatocellular carcinoma (HCC). We aimed to identify the different risk factors for overall, early, and late recurrence, and to establish nomograms based on inflammation-related parameters for predicting the risks of recurrence in a group of HCC patients undergoing hepatectomy.

Methods: We retrospectively enrolled 383 HCC patients with chronic hepatitis B (CHB) who underwent hepatectomy. Univariate and multivariate Cox analyses were conducted to identify independent risk factors for recurrence. Nomograms for overall, early, and late recurrence-free survival (RFS) were established. The discrimination and calibration abilities of the nomograms were evaluated by concordance indexes (C-index), calibration plots, and Kaplan-Meier curves. Finally, receiver operating characteristic (ROC) curves were used to compare the derived nomograms with other existing models.

Results: Fibrinogen, lymphocyte-to-monocyte ratio, and S-index inflammation-related factors were independently related to overall and early RFS, but only the S-index correlated with late recurrence. Nomograms with tumor number, diameter, and pathological differentiation for overall and early RFS were established, while nomogram for late recurrence was constructed with tumor number and Child-Pugh grade. The C-indexes for overall, early, and late RFS were 0.679, 0.677, and 0.728, respectively. The calibration plots fit well. The nomograms showed superior discrimination capacities and better performance prediction with larger areas under the curve for recurrence.

Conclusions: The developed nomograms that integrated inflammation-related factors showed high predictive accuracy for overall, early, and late recurrence in HCC patients with CHB after hepatectomy.

Keywords: Hepatocellular carcinoma (HCC); inflammation; nomogram; prognosis; recurrence.