Cancer Management and Research (May 2020)
Development and Validation of Pre- and Post-Operative Models to Predict Recurrence After Resection of Solitary Hepatocellular Carcinoma: A Multi-Institutional Study
Abstract
Ming-Yu Wu,1,* Qian Qiao,1,* Ke Wang,2– 4 Gu-Wei Ji,2– 4,* Bing Cai,1 Xiang-Cheng Li2– 4 1Department of Hepatobiliary Surgery, Wuxi People’s Hospital, Wuxi, People’s Republic of China; 2Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China; 3Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, Nanjing, People’s Republic of China; 4NHC Key Laboratory of Living Donor Liver Transplantation (Nanjing Medical University), Nanjing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xiang-Cheng LiHepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, People’s Republic of ChinaTel +86 18951999088Fax +86 2568136450Email [email protected] CaiDepartment of Hepatobiliary Surgery, Wuxi People’s Hospital, 299 Qingyang Road, Wuxi 214023, People’s Republic of ChinaTel +86 13358112071Fax +86 51082700778Email [email protected]: The ideal candidates for resection are patients with solitary hepatocellular carcinoma (HCC); however, postoperative recurrence rate remains high. We aimed to establish prognostic models to predict HCC recurrence based on readily accessible clinical parameters and multi-institutional databases.Patients and Methods: A total of 485 patients undergoing curative resection for solitary HCC were recruited from two independent institutions and the Cancer Imaging Archive database. We randomly divided the patients into training (n=323) and validation cohorts (n=162). Two models were developed: one using pre-operative and one using pre- and post-operative parameters. Performance of the models was compared with staging systems.Results: Using multivariable analysis, albumin-bilirubin grade, serum alpha-fetoprotein and tumor size were selected into the pre-operative model; albumin-bilirubin grade, serum alpha-fetoprotein, tumor size, microvascular invasion and cirrhosis were selected into the postoperative model. The two models exhibited better discriminative ability (concordance index: 0.673– 0.728) and lower prediction error (integrated Brier score: 0.169– 0.188) than currently used staging systems for predicting recurrence in both cohorts. Both models stratified patients into low- and high-risk subgroups of recurrence with distinct recurrence patterns.Conclusion: The two models with corresponding user-friendly calculators are useful tools to predict recurrence before and after resection that may facilitate individualized management of solitary HCC.Keywords: hepatocellular carcinoma, resection, recurrence, survival, modelling
