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Cancer Research and Treatment > Accepted Articles
doi: https://doi.org/10.4143/crt.2018.657    [Accepted]
Novel Prognostic Nomograms Based on Inflammation-Related Markers for Patients with Hepatocellular Carcinoma Underwent Hepatectomy
Yifei Wang1, Kaiyu Sun2, Jingxian Shen3, Bin Li4, Ming Kuang1,5, Qinghua Cao6, Sui Peng4,7
1Department of Liver Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
2Department of Gastrointestinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
3Department of Medical Imaging, Sun Yat-sen University Cancer Center, Guangzhou, China
4Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
5Division of Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
6Department of Pathology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
7Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
Correspondence  Qinghua Cao ,Tel: 86-20-87331780 , Fax: 86-20-87331780 , Email: caoqhua@mail.sysu.edu.cn
Sui Peng ,Tel: 86-20-87755766 , Fax: 86-20-87766335 , Email: pengsui@vip.163.com
Received: November 27, 2018;  Accepted: March 7, 2019.  Published online: March 11, 2019.
*Yifei Wang, Kaiyu Sun and Jingxian Shen contributed equally to this work.
ABSTRACT
Purpose
Hepatocellular carcinoma (HCC) is an aggressive disease with high recurrence rate. However, current staging systems were lack of predictive capacity for HCC recurrence. We aimed to develop prognostic nomograms based on inflammation-related markers for HCC patients underwent hepatectomy.
Materials and Methods
We recruited 889 surgically treated patients from two medical centres. Independent prognostic factors were identified by cox regression analyses. Nomograms for recurrence-free survival (RFS) and overall survival (OS) were established, and validated internally and externally. The performance, discrimination and calibration of nomograms were assessed, and compared with existed staging systems.
Results
Neutrophil to lymphocyte ratio (NLR) and gamma-glutamyl transpeptidase to platelet ratio (GPR) were the two inflammation-related factor that independently correlated with survival. NLR, GPR, international normalized ratio (INR), microvascular invasion, satellite lesions, tumour number, tumour diameter and macrovascular invasion were used to construct nomogram for RFS while GPR, total bilirubin, INR, α-fetoprotein, microvascular invasion, satellite lesions, tumour diameter, and macrovascular invasion were for OS. In the training cohort, the C-index of nomogram was 0.701 (95% confidence interval [CI], 0.669 to 0.732) for RFS and 0.761 (95% CI, 0.728 to 0.795) for OS. These results received both internal and external validation with C-index of 0.701 (95% CI, 0.647 to 0.755) and 0.707 (95% CI, 0.657 to 0.756) for RFS, and 0.706 (95% CI, 0.640 to 0.772) and 0.708 (95% CI, 0.646 to 0.771) for OS, respectively. The nomograms showed superior accuracy to conventional staging systems (p<0.001).
Conclusion
The nomograms based on inflammation-related markers are of high efficacy in predicting survival of HCC patients after hepatectomy, which will be valuable in guiding post-operative interventions and follow-ups.
Key words: Hepatocellular carcinoma, Inflammation, Resection, Survival, Nomograms
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