Journal of Hepatocellular Carcinoma (Jul 2023)

Development and Validation of Novel Models Including Tumor Micronecrosis for Predicting the Postoperative Survival of Patients with Hepatocellular Carcinoma

  • Sun X,
  • Wang Y,
  • Ge H,
  • Chen C,
  • Han X,
  • Sun K,
  • Wang M,
  • Wei X,
  • Ye M,
  • Zhang Q,
  • Liang T

Journal volume & issue
Vol. Volume 10
pp. 1181 – 1194

Abstract

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Xuqi Sun,1,* Yangyang Wang,2,3,* Hongbin Ge,2,3 Cao Chen,2,3 Xu Han,2,3 Ke Sun,4 Meng Wang,4 Xiaobao Wei,2,3 Mao Ye,2,3 Qi Zhang,2,3,5,6 Tingbo Liang2,3,5,6 1Department of Medical Oncology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China; 2Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China; 3Zhejiang Provincial Key Laboratory of Pancreatic Disease, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China; 4Department of Pathology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China; 5Zhejiang University Cancer Center, Hangzhou, People’s Republic of China; 6Zhejiang Clinical Research Center of Hepatobiliary and Pancreatic Diseases, Hangzhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Tingbo Liang; Qi Zhang, Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310003, People’s Republic of China, Tel/Fax +86-0571-87236601, Email [email protected]; [email protected]: The heterogeneity of hepatocellular carcinoma (HCC) leads to the unsatisfying predictive performance of current staging systems. HCC patients with pathological tumor micronecrosis have an immunosuppressive microenvironment. We aimed to develop novel prognostic models by integrating micronecrosis to predict the survival of HCC patients after hepatectomy more precisely.Methods: We enrolled 765 HCC patients receiving curative hepatic resection. They were randomly divided into a training cohort (n= 536) and a validation cohort (n = 229). We developed two prognostic models for postoperative recurrence-free survival (RFS) and overall survival (OS) based on independent factors identified through multivariate Cox regression analyses. The predictive performance was assessed using the Harrell concordance index (C-index) and the time-dependent area under the receiver operating characteristic curve, compared with six conventional staging systems.Results: The RFS and OS nomograms were developed based on tumor micronecrosis, tumor size, albumin-bilirubin grade, tumor number and prothrombin time. The C-indexes for the RFS nomogram and OS nomogram were respectively 0.66 (95% CI, 0.62– 0.69) and 0.74 (95% CI, 0.69– 0.79) in the training cohort, which was significantly better than those of the six common staging systems (0.52– 0.61 for RFS and 0.53– 0.63 for OS). The results were further confirmed in the validation group, with the C-indexes being 0.66 and 0.77 for the RFS and OS nomograms, respectively.Conclusion: The two nomograms could more accurately predict RFS and OS in HCC patients receiving curative hepatic resection, thereby aiding in formulating personalized postoperative follow-up plans.Keywords: hepatocellular carcinoma, micronecrosis, postoperative survival

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