A nomogram to predict prognosis of patients with large hepatocellular carcinoma: a study based on SEER database_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Wei ^1,2 , JIN Zongrui ^1,2 , WU Guolin ^1,2 , WANG Jue ^1,2 , YI Qilin ^1,2 , WANG Jilong ² , XU Banghao ² , ZHU Hai ² , PENG Tao ² ,  GUO Ya ² ,  WEN Zhang ²

1. Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, P. R. China;
2. The First Clinical Medical College of Guangxi Medical University, Nanning 530021, P. R. China;

Corresponding?author：

GUO Ya, Email: guoygxmu@163.com; WEN Zhang, Email: wenzgxmu@163.com

Keywords：

large hepatocellular carcinoma; The Surveillance, Epidemiology, and End Results Database; cancer specific survival; nomogram; prognosis prediction

DOI：

10.7507/1007-9424.202012042

Video：

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Objective To explore the influencing factors of cancer-specific survival of patients with large hepatocellular carcinoma, and draw a nomogram to predict the cancer-specific survival rate of large hepatocellular carcinoma patients.Methods The clinicopathological data of patients with large hepatocellular carcinoma during the period from 1975 to 2017 in the Surveillance, Epidemiology, and End Results (SEER) database were searched and randomly divided into training group and validation group at 1∶1. Using the training data, the Cox proportional hazard regression model was used to explore the influencing factors of cancer-specific survival and construct the nomogram; finally, the receiver operating characteristic curve (ROC curve) and the calibration curve were drawn to verify the nomogram internally and externally.Results The results of the multivariate Cox proportional hazard regression model showed that the degree of liver cirrhosis, tumor differentiation, tumor diameter, T stage, M stage, surgery, and chemotherapy were independent influencing factors that affect the specific survival of patients with large hepatocellular carcinoma (P<0.05), and then these factors were enrolled into the nomogram of the prediction model. The areas under the 1, 3, and 5-year curves of the training group were 0.800, 0.827, and 0.814, respectively; the areas under the 1, 3, and 5-year curves of the validation group were 0.800, 0.824, and 0.801, respectively. The C index of the training group was 0.779, and the verification group was 0.777. The calibration curve of the training group and the verification group was close to the ideal curve of the actual situation.Conclusion The nomogram of the prediction model drawn in this study can be used to predict the specific survival of patients with large hepatocellular carcinoma in the clinic.

Citation： WANG Wei, JIN Zongrui, WU Guolin, WANG Jue, YI Qilin, WANG Jilong, XU Banghao, ZHU Hai, PENG Tao, GUO Ya, WEN Zhang. A nomogram to predict prognosis of patients with large hepatocellular carcinoma: a study based on SEER database. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(8): 1016-1024. doi: 10.7507/1007-9424.202012042 Copy

1.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin,2021 Feb 4, [Online ahead of print].
2.	楊連粵. 孤立性大肝癌的外科治療進展. 中華外科雜志, 2020, 58(1): 13-16.
3.	王兵, 閻立凱. 腹腔鏡下解剖性肝切除術對原發性肝癌的療效及對相關血清學指標和預后的影響. 肝臟, 2019, 24(3): 283-285.
4.	莊盛威, 林燕燕. 不同肝血流阻斷方法對外科手術切除原發性大肝癌患者療效的影響. 中國現代醫生, 2018, 56(29): 38-40.
5.	宋祥勇, 張軍, 張永川. 腹腔鏡肝切除術與開腹肝切除術治療原發性大肝癌近期療效及遠期預后對比分析. 解放軍預防醫學雜志, 2018, 36(4): 451-454.
6.	Duggan MA, Anderson WF, Altekruse S, et al. The Surveillance, Epidemiology, and End Results (SEER) program and pathology: toward strengthening the critical relationship. Am J Surg Pathol, 2016, 40(12): e94-e102.
7.	Iasonos A, Schrag D, Raj GV, et al. How to build and interpret a nomogram for cancer prognosis. J Clin Oncol, 2008, 26(8): 1364-1370.
8.	Kattan MW, Scardino PT. Evidence for the usefulness of nomograms. Nat Clin Pract Urol, 2007, 4(12): 638-639.
9.	Fakhry C, Zhang Q, Nguyen-Tan PF, et al. Development and validation of nomograms predictive of overall and progression-free survival in patients with oropharyngeal cancer. J Clin Oncol, 2017, 35(36): 4057-4065.
10.	Lee CK, Goldstein D, Gibbs E, et al. Development and validation of prognostic nomograms for metastatic gastrointestinal stromal tumour treated with imatinib. Eur J Cancer, 2015, 51(7): 852-860.
11.	Ganly I, Amit M, Kou L, et al. Nomograms for predicting survival and recurrence in patients with adenoid cystic carcinoma. An international collaborative study. Eur J Cancer, 2015, 51(18): 2768-2776.
12.	Mitra AP, Lam LL, Ghadessi M, et al. Discovery and validation of novel expression signature for postcystectomy recurrence in high-risk bladder cancer. J Natl Cancer Inst, 2014, 106(11): dju290.
13.	Kao WY, Su CW, Chiou YY, et al. Hepatocellular carcinoma: nomograms based on the albumin-bilirubin grade to assess the outcomes of radiofrequency ablation. Radiology, 2017, 285(2): 670-680.
14.	Shim JH, Jun MJ, Han S, et al. Prognostic nomograms for prediction of recurrence and survival after curative liver resection for hepatocellular carcinoma. Ann Surg, 2015, 261(5): 939-946.
15.	He W, Peng B, Tang Y, et al. Nomogram to predict survival of patients with recurrence of hepatocellular carcinoma after surgery. Clin Gastroenterol Hepatol, 2018, 16(5): 756-764. e10.
16.	Xu L, Peng ZW, Chen MS, et al. Prognostic nomogram for patients with unresectable hepatocellular carcinoma after transcatheter arterial chemoembolization. J Hepatol, 2015, 63(1): 122-130.
17.	Kong J, Wang T, Shen S, et al. A nomogram predicting the prognosis of young adult patients diagnosed with hepatocellular carcinoma: A population-based analysis. PLoS One, 2019, 14(7): e0219654.
18.	Benson AB, D’Angelica MI, Abbott DE, et al. Guidelines insights: hepatobiliary cancers, version 2. 2019. J Natl Compr Canc Netw, 2019, 17(4): 302-310.
19.	Hwang S, Lee YJ, Kim KH, et al. The impact of tumor size on long-term survival outcomes after resection of solitary hepatocellular carcinoma: single-institution experience with 2 558 patients. J Gastrointest Surg, 2015, 19(7): 1281-1290.
20.	Goh BK, Teo JY, Chan CY, et al. Importance of tumor size as a prognostic factor after partial liver resection for solitary hepatocellular carcinoma: Implications on the current AJCC staging system. J Surg Oncol, 2016, 113(1): 89-93.
21.	Subramaniam S, Kelley RK, Venook AP. A review of hepatocellular carcinoma (HCC) staging systems. Chin Clin Oncol, 2013, 2(4): 33.
22.	Tateishi R, Yoshida H, Matsuyama Y, et al. Diagnostic accuracy of tumor markers for hepatocellular carcinoma: a systematic review. Hepatol Int, 2008, 2(1): 17-30.
23.	Liu C, Xiao GQ, Yan LN, et al. Value of α-fetoprotein in association with clinicopathological features of hepatocellular carcinoma. World J Gastroenterol, 2013, 19(11): 1811-1819.
24.	Di Tommaso L, Sangiovanni A, Borzio M, et al. Advanced precancerous lesions in the liver. Best Pract Res Clin Gastroenterol, 2013, 27(2): 269-284.
25.	Techathuvanan K, Srisajjakul S, Pongpaibul A, et al. Comparison between disease free survival of hepatocellular carcinoma after hepatic resection in chronic hepatitis B patients with or without cirrhosis. J Med Assoc Thai, 2015, 98(4): 334-342.
26.	閻濤, 畢新宇, 方儀, 等. 肝細胞肝癌術后預后因素分析. 實用腫瘤雜志, 2011, 26(4): 337-339.
27.	Vauthey JN, Lauwers GY. Prognostic factors after resection of hepatocellular carcinoma: are there landmarks in the wild forest? J Hepatol, 2003, 38(2): 237-239.
28.	唐波, 胡志強, 倪斌. 腹腔鏡肝切除術與開腹肝切除術治療原發性大肝癌臨床效果的比較研究. 臨床合理用藥雜志, 2020, 13(3): 142-143.
29.	中國抗癌協會肝癌專業委員會. 原發性肝癌的臨床診斷與分期標準. 中華肝臟病雜志, 2001, 9(6): 324.
30.	李彩霞, 張揚, 高莉. 原發性肝癌的介入綜合治療及其預后影響因素. 中華腫瘤雜志, 2006, 28(12): 942-945.
31.	徐向賢, 梁定, 李正軍, 等. 肝動脈化療栓塞聯合微波消融術治療大肝癌的近期療效探析. 醫藥前沿, 2020, 10(29): 115-116.
32.	Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol, 2010, 17(6): 1471-1474.
33.	Shen SL, Fu SJ, Chen B, et al. Preoperative aspartate aminotransferase to platelet ratio is an independent prognostic factor for hepatitis B-induced hepatocellular carcinoma after hepatic resection. Ann Surg Oncol, 2014, 21(12): 3802-3809.
34.	Lu XY, Xi T, Lau WY, et al. Pathobiological features of small hepatocellular carcinoma: correlation between tumor size and biological behavior. J Cancer Res Clin Oncol, 2011, 137(4): 567-575.
35.	Yan B, Bai DS, Zhang C, et al. Characteristics and risk differences of different tumor sizes on distant metastases of hepatocellular carcinoma: A retrospective cohort study in the SEER database. Int J Surg, 2020, 80: 94-100.

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin,2021 Feb 4, [Online ahead of print].
2. 楊連粵. 孤立性大肝癌的外科治療進展. 中華外科雜志, 2020, 58(1): 13-16.
3. 王兵, 閻立凱. 腹腔鏡下解剖性肝切除術對原發性肝癌的療效及對相關血清學指標和預后的影響. 肝臟, 2019, 24(3): 283-285.
4. 莊盛威, 林燕燕. 不同肝血流阻斷方法對外科手術切除原發性大肝癌患者療效的影響. 中國現代醫生, 2018, 56(29): 38-40.
5. 宋祥勇, 張軍, 張永川. 腹腔鏡肝切除術與開腹肝切除術治療原發性大肝癌近期療效及遠期預后對比分析. 解放軍預防醫學雜志, 2018, 36(4): 451-454.
6. Duggan MA, Anderson WF, Altekruse S, et al. The Surveillance, Epidemiology, and End Results (SEER) program and pathology: toward strengthening the critical relationship. Am J Surg Pathol, 2016, 40(12): e94-e102.
7. Iasonos A, Schrag D, Raj GV, et al. How to build and interpret a nomogram for cancer prognosis. J Clin Oncol, 2008, 26(8): 1364-1370.
8. Kattan MW, Scardino PT. Evidence for the usefulness of nomograms. Nat Clin Pract Urol, 2007, 4(12): 638-639.
9. Fakhry C, Zhang Q, Nguyen-Tan PF, et al. Development and validation of nomograms predictive of overall and progression-free survival in patients with oropharyngeal cancer. J Clin Oncol, 2017, 35(36): 4057-4065.
10. Lee CK, Goldstein D, Gibbs E, et al. Development and validation of prognostic nomograms for metastatic gastrointestinal stromal tumour treated with imatinib. Eur J Cancer, 2015, 51(7): 852-860.
11. Ganly I, Amit M, Kou L, et al. Nomograms for predicting survival and recurrence in patients with adenoid cystic carcinoma. An international collaborative study. Eur J Cancer, 2015, 51(18): 2768-2776.
12. Mitra AP, Lam LL, Ghadessi M, et al. Discovery and validation of novel expression signature for postcystectomy recurrence in high-risk bladder cancer. J Natl Cancer Inst, 2014, 106(11): dju290.
13. Kao WY, Su CW, Chiou YY, et al. Hepatocellular carcinoma: nomograms based on the albumin-bilirubin grade to assess the outcomes of radiofrequency ablation. Radiology, 2017, 285(2): 670-680.
14. Shim JH, Jun MJ, Han S, et al. Prognostic nomograms for prediction of recurrence and survival after curative liver resection for hepatocellular carcinoma. Ann Surg, 2015, 261(5): 939-946.
15. He W, Peng B, Tang Y, et al. Nomogram to predict survival of patients with recurrence of hepatocellular carcinoma after surgery. Clin Gastroenterol Hepatol, 2018, 16(5): 756-764. e10.
16. Xu L, Peng ZW, Chen MS, et al. Prognostic nomogram for patients with unresectable hepatocellular carcinoma after transcatheter arterial chemoembolization. J Hepatol, 2015, 63(1): 122-130.
17. Kong J, Wang T, Shen S, et al. A nomogram predicting the prognosis of young adult patients diagnosed with hepatocellular carcinoma: A population-based analysis. PLoS One, 2019, 14(7): e0219654.
18. Benson AB, D’Angelica MI, Abbott DE, et al. Guidelines insights: hepatobiliary cancers, version 2. 2019. J Natl Compr Canc Netw, 2019, 17(4): 302-310.
19. Hwang S, Lee YJ, Kim KH, et al. The impact of tumor size on long-term survival outcomes after resection of solitary hepatocellular carcinoma: single-institution experience with 2 558 patients. J Gastrointest Surg, 2015, 19(7): 1281-1290.
20. Goh BK, Teo JY, Chan CY, et al. Importance of tumor size as a prognostic factor after partial liver resection for solitary hepatocellular carcinoma: Implications on the current AJCC staging system. J Surg Oncol, 2016, 113(1): 89-93.
21. Subramaniam S, Kelley RK, Venook AP. A review of hepatocellular carcinoma (HCC) staging systems. Chin Clin Oncol, 2013, 2(4): 33.
22. Tateishi R, Yoshida H, Matsuyama Y, et al. Diagnostic accuracy of tumor markers for hepatocellular carcinoma: a systematic review. Hepatol Int, 2008, 2(1): 17-30.
23. Liu C, Xiao GQ, Yan LN, et al. Value of α-fetoprotein in association with clinicopathological features of hepatocellular carcinoma. World J Gastroenterol, 2013, 19(11): 1811-1819.
24. Di Tommaso L, Sangiovanni A, Borzio M, et al. Advanced precancerous lesions in the liver. Best Pract Res Clin Gastroenterol, 2013, 27(2): 269-284.
25. Techathuvanan K, Srisajjakul S, Pongpaibul A, et al. Comparison between disease free survival of hepatocellular carcinoma after hepatic resection in chronic hepatitis B patients with or without cirrhosis. J Med Assoc Thai, 2015, 98(4): 334-342.
26. 閻濤, 畢新宇, 方儀, 等. 肝細胞肝癌術后預后因素分析. 實用腫瘤雜志, 2011, 26(4): 337-339.
27. Vauthey JN, Lauwers GY. Prognostic factors after resection of hepatocellular carcinoma: are there landmarks in the wild forest? J Hepatol, 2003, 38(2): 237-239.
28. 唐波, 胡志強, 倪斌. 腹腔鏡肝切除術與開腹肝切除術治療原發性大肝癌臨床效果的比較研究. 臨床合理用藥雜志, 2020, 13(3): 142-143.
29. 中國抗癌協會肝癌專業委員會. 原發性肝癌的臨床診斷與分期標準. 中華肝臟病雜志, 2001, 9(6): 324.
30. 李彩霞, 張揚, 高莉. 原發性肝癌的介入綜合治療及其預后影響因素. 中華腫瘤雜志, 2006, 28(12): 942-945.
31. 徐向賢, 梁定, 李正軍, 等. 肝動脈化療栓塞聯合微波消融術治療大肝癌的近期療效探析. 醫藥前沿, 2020, 10(29): 115-116.
32. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol, 2010, 17(6): 1471-1474.
33. Shen SL, Fu SJ, Chen B, et al. Preoperative aspartate aminotransferase to platelet ratio is an independent prognostic factor for hepatitis B-induced hepatocellular carcinoma after hepatic resection. Ann Surg Oncol, 2014, 21(12): 3802-3809.
34. Lu XY, Xi T, Lau WY, et al. Pathobiological features of small hepatocellular carcinoma: correlation between tumor size and biological behavior. J Cancer Res Clin Oncol, 2011, 137(4): 567-575.
35. Yan B, Bai DS, Zhang C, et al. Characteristics and risk differences of different tumor sizes on distant metastases of hepatocellular carcinoma: A retrospective cohort study in the SEER database. Int J Surg, 2020, 80: 94-100.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

A nomogram to predict prognosis of patients with large hepatocellular carcinoma: a study based on SEER database

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