Prognostic factors and survival prediction in hepatocellular carcinoma: development and validation of a novel nomogram based on the SEER database

Shanshan Huang; Zheng Zhu; Yejiao Ruan; Fayuan Zhang; Yueting Xu; Lingxiang Jin; Victor Lopez-Lopez; Philippe Merle; Guangrong Lu; Liyi Li

doi:10.21037/jgo-23-427

Prognostic factors and survival prediction in hepatocellular carcinoma: development and validation of a novel nomogram based on the SEER database

J Gastrointest Oncol. 2023 Aug 31;14(4):1817-1829. doi: 10.21037/jgo-23-427. Epub 2023 Jul 21.

Authors

Shanshan Huang^#¹, Zheng Zhu^#², Yejiao Ruan³, Fayuan Zhang², Yueting Xu², Lingxiang Jin¹, Victor Lopez-Lopez⁴, Philippe Merle⁵, Guangrong Lu³, Liyi Li⁶

Affiliations

¹ Department of Infectious Disease, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.
² The Second Clinical Medical College, Wenzhou Medical University, Wenzhou, China.
³ Department of Gastroenterology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.
⁴ Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain.
⁵ Hepatology Unit, University Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France.
⁶ Department of Gastrointestinal Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.

^# Contributed equally.

Abstract

Background: Current staging systems for hepatocellular carcinoma (HCC) still have limitations in clinical practice. Our study aimed to explore the prognostic factors and develop a new nomogram to predict the cancer-specific survival (CSS) for patients with HCC.

Methods: A total of 6,166 HCC patients were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were randomly grouped into the training cohort (70%) and validation cohort (30%). Multivariate Cox analysis was used to identify prognostics factors for CSS of patients, then we incorporated these variables and presented a new nomogram to predict 2- and 5-year CSS. The performance of the nomogram was assessed with respect to its calibration, concordance index (C-index), area under the receiver operating characteristic (ROC) curve (AUC), and decision curve analysis (DCA).

Results: Multivariate Cox analysis revealed that American Joint Committee on Cancer (AJCC) stage, race, grade, surgery, chemotherapy, radiation, tumor size, bone metastasis (BM), and alpha-fetoprotein (AFP) were independently associated with CSS. The prediction nomogram which contained these predictors showed good performance, with a C-index of 0.802 [95% confidence interval (CI), 0.792-0.812] in the training cohort and 0.801 (95% CI, 0.787-0.815) in the validation cohort. The calibration curves demonstrated good agreement between the actual observation and the nomogram prediction. Furthermore, the nomogram showed improved discriminative capacity (AUC, 0.873 and 0.875 for 2- and 5-year CSS in validation set) compared to the 7^th tumor-node-metastasis (TNM) staging system (AUC, 0.735 and 0.717). The DCA also indicated good application of the nomogram.

Conclusions: This study presents a novel nomogram that incorporates the important prognostic factors of HCC, which can be conveniently used to accurately predict the 2- and 5-year CSS of patients with HCC, thus assisting individualized clinical decision making.

Keywords: Hepatocellular carcinoma (HCC); cancer-specific survival (CSS); nomogram; prognostic factors.