Nomograms to predict prognosis of hepatocelluar carcinoma without major vascular invasion after primary liver transplantation

Abstract

Background: A model to predict individual prognosis after liver transplantation (LT) has not been clearly established. We aimed to create nomograms for prediction of individual survival after LT for hepatocelluar carcinoma (HCC).

Results: There were 128(61.2%) patients within the Milan criteria. Before transplantation, 43 (20.6%) patients received transcatheter arterial chemoembolization (TACE) and 22 (10.5%) received radiofrequency ablation(RFA). Multivariate predictors of survival included tumor size, tumor number and tumor differentiation. Nomograms for OS and recurrence free survival (RFS) have been created. Discrimination and calibration of the nomograms revealed good predictive abilities(C-index, RFS: 0.74; OS: 0.70). Compared with Milan criteria, UCSF criteria, up-to-seven criteria and Hangzhou criteria, the OS nomogram improved accuracy in predicting prognosis after transplantation for HCC, (p < 0.05 for all). Finally, three subgroups were generated based on the total risk points (A’: 1.88–76.5 points; B’: 76.6–113.9points; C’: 113.9–151.3points). The 5-year survival rate were 86.1% for group A’, 59.1% for group B’, and 28.9% for group C’, respectively.

Conclusions: The nomograms had good ability in predicting prognostic survival for HCC patients after LT. Patients with score above 113.9 points had poor survival after LT.

Materials and method: Between Juanuary 2002 and September 2015, 209 HCC patients who received liver transplantation in the West China Hospital were collected for this study. Prognostic nomograms predicting post-transplant prognosis were developed from a multivariate cox regression. The prediction power of the nomograms was tested by C-statistic and calibration plots.