Research Papers:

Nomogram for preoperative estimation of long-term survival of patients who underwent curative resection with hepatocellular carcinoma beyond Barcelona clinic liver cancer stage A1

Dan-Yun Ruan, Ze-Xiao Lin, Tian-Tian Wang, Hui Zhao, Dong-Hao Wu, Jie Chen, Min Dong, Qu Lin, Xiang-Yuan Wu and Yang Li _

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Oncotarget. 2016; 7:61378-61389. https://doi.org/10.18632/oncotarget.11358

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Dan-Yun Ruan1,*, Ze-Xiao Lin1,*, Tian-Tian Wang1,*, Hui Zhao2, Dong-Hao Wu1, Jie Chen1, Min Dong1, Qu Lin1, Xiang-Yuan Wu1, Yang Li2

1Department of Medical Oncology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangdong, China

2Department of Liver Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China

*These authors contributed equally to this work

Correspondence to:

Yang Li, email: [email protected]

Xiang-Yuan Wu, email: [email protected]

Keywords: hepatocellular carcinoma, Barcelona clinic liver cancer stage, resection, nomogram, survival

Received: April 10, 2016     Accepted: August 10, 2016     Published: August 17, 2016


Background and Aims: This retrospective cohort study developed a prognostic nomogram to predict the survival of hepatocellular carcinoma (HCC) patients diagnosed as beyond Barcelona clinic liver cancer stage A1 after resection and evaluated the possibility of using the nomogram as a treatment algorithm reference.

Results: The predictors included in the nomogram were total tumour volume, Child-Turcotte-Pugh class, plasma fibrinogen and portal vein tumour thrombus. Patients diagnosed as beyond A1 were stratified into low-, medium- and high-risk groups using nomogram scores of 0 and 51 with the total points of 225. Patients within A1 exhibited similar recurrence-free survival (RFS) and overall survival (OS) rates compared with the low-risk group. Patients in the medium-risk group exhibited a similar OS but a worse RFS rates compared with patients within A1. The high-risk group was associated with worse RFS and OS rates compared with the patients within A1 (3-year RFS rates, 27.0% vs. 60.3%, P < 0.001; 3-year OS rates, 49.2% vs. 83.1%, P < 0.001).

Methods: A total of 352 HCC patients undergoing curative resection from September 2003 to December 2012 were included to develop a nomogram to predict overall survival after resection. Univariate and multivariate survival analysis were used to identify prognostic factors. A visually orientated nomogram was constructed using a Cox proportional hazards model.

Conclusions: This user-friendly nomogram offers an individualized preoperative recurrence risk estimation and stratification for HCC patients beyond A1 undergoing resection. Resection should be considered the first-line treatment for low-risk patients.

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