Tumor Response and Nomogram-Based Prognostic Stratification for Hepatocellular Carcinoma After Drug-Eluting Beads Transarterial Chemoembolization

Abstract

Kun Ji,1,* Hanlong Zhu,2,* Wei Wu,3,* Xin Li,4 Pengchao Zhan,4 Yang Shi,4 Junhui Sun,1 Zhen Li4 1Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, People’s Republic of China; 2Department of Gastroenterology and Hepatology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, People’s Republic of China; 3Department of Medical Oncology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, People’s Republic of China; 4Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People’s Republic of China*These authors contributed equally to this workCorrespondence: Zhen Li, Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, No. 1 East Jian She Road, Zhengzhou, 450052, People’s Republic of China, Tel [phone], Email [email protected] Junhui Sun, Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310000, People’s Republic of China, Tel [phone], Email [email protected]: To explore the tumor response and propose a nomogram-based prognostic stratification for hepatocellular carcinoma (HCC) after drug-eluting beads transarterial chemoembolization (DEB-TACE).Patients and Methods: From the database of two centers, patients who received DEB-TACE as an initial treatment were enrolled and divided into the training and validation sets. The tumor response after DEB-TACE was estimated according to the Modified Response Evaluation Criteria in Solid Tumors. Using the independent survival predictors in the training set, a nomogram was constructed and validated internally and externally by measuring concordance index (C-index) and calibration. A prognostic stratification based on the nomogram was established.Results: A total of 335 patients met the inclusion criteria for the study. Alkaline phosphatase level, tumor maximum diameter, tumor capsule and portal vein invasion were interrelated with the achievement of complete release after DEB-TACE. Alpha-fetoprotein level, Child-Pugh class, tumor maximum diameter, tumor number, tumor extent and portal vein invasion were integrated into the nomogram. The nomogram demonstrated good calibration and discrimination, with C-indexes of 0.735 and 0.854 and higher area under the curve (AUC) than BCLC and CNLC staging systems in the internal and external validation sets. The prognostic stratification classified patients into three different risk groups, which had significant differences in survival, complete release and objective response rate between any two groups (P < 0.05).Conclusion: The nomogram-based prognostic stratification has a good distinction and may help to identify the patients benefiting from DEB-TACE.Keywords: hepatocellular carcinoma, drug-eluting beads, nomogram, prediction, transarterial chemoembolization

Keywords

• hepatocellular carcinoma
• drug-eluting beads
• nomogram
• prediction
• transarterial chemoembolization