A nomogram to predict survival of patients with intermediate-stage hepatocellular carcinoma after transarterial chemoembolization combined with microwave ablation

Jia yan Ni, Zhu ting Fang, Hong liang Sun, Chao An, Zhi mei Huang, Tian qi Zhang, Xiong ying Jiang, Yao ting Chen, Lin feng Xu, Jin hua Huang

Research output: Contribution to journalArticle

Abstract

Objectives: To develop a prognostic nomogram based on the albumin–bilirubin (ALBI) grade for prediction of the long-term survival of patients with intermediate-stage hepatocellular carcinoma (HCC) after transarterial chemoembolization combined with microwave ablation (TACE-MWA). Methods: We retrospectively studied 546 consecutive patients with intermediate-stage HCC according to the Barcelona Clinic Liver Cancer guidelines who underwent TACE-MWA between January 2000 and December 2016. Overall survival (OS) and progression-free survival (PFS) were analyzed. The predictive value of the ALBI grade was investigated. The prognostic nomogram was constructed using the independent predictors assessed by the multivariate Cox proportional hazards model. Results: After a median follow-up of 35.0 months (range, 4.0–221.0 months), 380 patients had died. The median OS was 35.0 months (95% confidence interval (CI), 30.84–39.16 months), and the median PFS was 6.5 months (95% CI, 6.13–6.87 months). The ALBI grade was validated as an independent predictor of OS (p < 0.001). Multivariate analyses showed that Eastern Cooperative Oncology Group performance status score more than 0, presence of liver cirrhosis, a-fetoprotein level above 400 ng/mL, tumor size greater than 5 cm, tumor number more than 3, advanced ALBI grade, and treatment sessions of TACE or MWA fewer than 3 were independently associated with overall mortality. The prognostic nomogram incorporating these eight predictors achieved good calibration and discriminatory abilities with a concordance index of 0.770 (95% CI, 0.746–0.795). Conclusions: The prognostic nomogram based on the ALBI grade resulted in reliable efficacy for prediction of individualized OS in patients with intermediate-stage HCC after TACE-MWA. Key Points: • TACE-MWA was associated with a median overall survival of 35.0 months for patients with intermediate-stage HCC. • A prognostic nomogram was built to predict individualized survival of patients with intermediate-stage HCC after TACE-MWA. • The prognostic nomogram incorporating eight predictors achieved good calibration and discriminatory abilities with a concordance index of 0.770.

Original languageEnglish (US)
JournalEuropean Radiology
DOIs
StateAccepted/In press - Jan 1 2020

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Nomograms
Microwaves
Hepatocellular Carcinoma
Survival
Confidence Intervals
Calibration
Disease-Free Survival
Fetal Proteins
Liver Neoplasms
Proportional Hazards Models
Liver Cirrhosis
Neoplasms
Multivariate Analysis
Guidelines
Mortality

Keywords

  • Ablation technique
  • Chemoembolization, therapeutic
  • Hepatocellular carcinoma
  • Nomogram
  • Survival

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

A nomogram to predict survival of patients with intermediate-stage hepatocellular carcinoma after transarterial chemoembolization combined with microwave ablation. / Ni, Jia yan; Fang, Zhu ting; Sun, Hong liang; An, Chao; Huang, Zhi mei; Zhang, Tian qi; Jiang, Xiong ying; Chen, Yao ting; Xu, Lin feng; Huang, Jin hua.

In: European Radiology, 01.01.2020.

Research output: Contribution to journalArticle

Ni, Jia yan ; Fang, Zhu ting ; Sun, Hong liang ; An, Chao ; Huang, Zhi mei ; Zhang, Tian qi ; Jiang, Xiong ying ; Chen, Yao ting ; Xu, Lin feng ; Huang, Jin hua. / A nomogram to predict survival of patients with intermediate-stage hepatocellular carcinoma after transarterial chemoembolization combined with microwave ablation. In: European Radiology. 2020.
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abstract = "Objectives: To develop a prognostic nomogram based on the albumin–bilirubin (ALBI) grade for prediction of the long-term survival of patients with intermediate-stage hepatocellular carcinoma (HCC) after transarterial chemoembolization combined with microwave ablation (TACE-MWA). Methods: We retrospectively studied 546 consecutive patients with intermediate-stage HCC according to the Barcelona Clinic Liver Cancer guidelines who underwent TACE-MWA between January 2000 and December 2016. Overall survival (OS) and progression-free survival (PFS) were analyzed. The predictive value of the ALBI grade was investigated. The prognostic nomogram was constructed using the independent predictors assessed by the multivariate Cox proportional hazards model. Results: After a median follow-up of 35.0 months (range, 4.0–221.0 months), 380 patients had died. The median OS was 35.0 months (95{\%} confidence interval (CI), 30.84–39.16 months), and the median PFS was 6.5 months (95{\%} CI, 6.13–6.87 months). The ALBI grade was validated as an independent predictor of OS (p < 0.001). Multivariate analyses showed that Eastern Cooperative Oncology Group performance status score more than 0, presence of liver cirrhosis, a-fetoprotein level above 400 ng/mL, tumor size greater than 5 cm, tumor number more than 3, advanced ALBI grade, and treatment sessions of TACE or MWA fewer than 3 were independently associated with overall mortality. The prognostic nomogram incorporating these eight predictors achieved good calibration and discriminatory abilities with a concordance index of 0.770 (95{\%} CI, 0.746–0.795). Conclusions: The prognostic nomogram based on the ALBI grade resulted in reliable efficacy for prediction of individualized OS in patients with intermediate-stage HCC after TACE-MWA. Key Points: • TACE-MWA was associated with a median overall survival of 35.0 months for patients with intermediate-stage HCC. • A prognostic nomogram was built to predict individualized survival of patients with intermediate-stage HCC after TACE-MWA. • The prognostic nomogram incorporating eight predictors achieved good calibration and discriminatory abilities with a concordance index of 0.770.",
keywords = "Ablation technique, Chemoembolization, therapeutic, Hepatocellular carcinoma, Nomogram, Survival",
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T1 - A nomogram to predict survival of patients with intermediate-stage hepatocellular carcinoma after transarterial chemoembolization combined with microwave ablation

AU - Ni, Jia yan

AU - Fang, Zhu ting

AU - Sun, Hong liang

AU - An, Chao

AU - Huang, Zhi mei

AU - Zhang, Tian qi

AU - Jiang, Xiong ying

AU - Chen, Yao ting

AU - Xu, Lin feng

AU - Huang, Jin hua

PY - 2020/1/1

Y1 - 2020/1/1

N2 - Objectives: To develop a prognostic nomogram based on the albumin–bilirubin (ALBI) grade for prediction of the long-term survival of patients with intermediate-stage hepatocellular carcinoma (HCC) after transarterial chemoembolization combined with microwave ablation (TACE-MWA). Methods: We retrospectively studied 546 consecutive patients with intermediate-stage HCC according to the Barcelona Clinic Liver Cancer guidelines who underwent TACE-MWA between January 2000 and December 2016. Overall survival (OS) and progression-free survival (PFS) were analyzed. The predictive value of the ALBI grade was investigated. The prognostic nomogram was constructed using the independent predictors assessed by the multivariate Cox proportional hazards model. Results: After a median follow-up of 35.0 months (range, 4.0–221.0 months), 380 patients had died. The median OS was 35.0 months (95% confidence interval (CI), 30.84–39.16 months), and the median PFS was 6.5 months (95% CI, 6.13–6.87 months). The ALBI grade was validated as an independent predictor of OS (p < 0.001). Multivariate analyses showed that Eastern Cooperative Oncology Group performance status score more than 0, presence of liver cirrhosis, a-fetoprotein level above 400 ng/mL, tumor size greater than 5 cm, tumor number more than 3, advanced ALBI grade, and treatment sessions of TACE or MWA fewer than 3 were independently associated with overall mortality. The prognostic nomogram incorporating these eight predictors achieved good calibration and discriminatory abilities with a concordance index of 0.770 (95% CI, 0.746–0.795). Conclusions: The prognostic nomogram based on the ALBI grade resulted in reliable efficacy for prediction of individualized OS in patients with intermediate-stage HCC after TACE-MWA. Key Points: • TACE-MWA was associated with a median overall survival of 35.0 months for patients with intermediate-stage HCC. • A prognostic nomogram was built to predict individualized survival of patients with intermediate-stage HCC after TACE-MWA. • The prognostic nomogram incorporating eight predictors achieved good calibration and discriminatory abilities with a concordance index of 0.770.

AB - Objectives: To develop a prognostic nomogram based on the albumin–bilirubin (ALBI) grade for prediction of the long-term survival of patients with intermediate-stage hepatocellular carcinoma (HCC) after transarterial chemoembolization combined with microwave ablation (TACE-MWA). Methods: We retrospectively studied 546 consecutive patients with intermediate-stage HCC according to the Barcelona Clinic Liver Cancer guidelines who underwent TACE-MWA between January 2000 and December 2016. Overall survival (OS) and progression-free survival (PFS) were analyzed. The predictive value of the ALBI grade was investigated. The prognostic nomogram was constructed using the independent predictors assessed by the multivariate Cox proportional hazards model. Results: After a median follow-up of 35.0 months (range, 4.0–221.0 months), 380 patients had died. The median OS was 35.0 months (95% confidence interval (CI), 30.84–39.16 months), and the median PFS was 6.5 months (95% CI, 6.13–6.87 months). The ALBI grade was validated as an independent predictor of OS (p < 0.001). Multivariate analyses showed that Eastern Cooperative Oncology Group performance status score more than 0, presence of liver cirrhosis, a-fetoprotein level above 400 ng/mL, tumor size greater than 5 cm, tumor number more than 3, advanced ALBI grade, and treatment sessions of TACE or MWA fewer than 3 were independently associated with overall mortality. The prognostic nomogram incorporating these eight predictors achieved good calibration and discriminatory abilities with a concordance index of 0.770 (95% CI, 0.746–0.795). Conclusions: The prognostic nomogram based on the ALBI grade resulted in reliable efficacy for prediction of individualized OS in patients with intermediate-stage HCC after TACE-MWA. Key Points: • TACE-MWA was associated with a median overall survival of 35.0 months for patients with intermediate-stage HCC. • A prognostic nomogram was built to predict individualized survival of patients with intermediate-stage HCC after TACE-MWA. • The prognostic nomogram incorporating eight predictors achieved good calibration and discriminatory abilities with a concordance index of 0.770.

KW - Ablation technique

KW - Chemoembolization, therapeutic

KW - Hepatocellular carcinoma

KW - Nomogram

KW - Survival

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