A novel prognostic nomogram is more accurate than conventional staging systems for predicting survival after resection of hepatocellular carcinoma Journal Article


Authors: Cho, C. S.; Gonen, M.; Shia, J.; Kattan, M. W.; Klimstra, D. S.; Jarnagin, W. R.; D'Angelica, M. I.; Blumgart, L. H.; DeMatteo, R. P.
Article Title: A novel prognostic nomogram is more accurate than conventional staging systems for predicting survival after resection of hepatocellular carcinoma
Abstract: Background: Prediction of survival after resection of hepatocellular carcinoma (HCC) remains difficult. Numerous staging systems have been devised for purposes of risk classification; we sought to identify the optimal staging system to predict postoperative survival. Study Design: One hundred eighty-four patients who underwent primary complete resection of HCC at our institution between 1989 and 2002 were classified according to 8 contemporary staging systems. The ability of these systems to predict relative survival for randomly selected pairs of patients was quantified using the Harrel's concordance index. A novel prognostic nomogram was constructed using prognostically relevant variables. Results: After a median followup of 46 months for surviving patients, the median overall survival was 38 months. The concordance indices for the existing staging systems ranged from 0.54 to 0.59. Only the 2002 American Joint Commission on Cancer system demonstrated a concordance index with a 95% confidence interval exceeding 0.5, indicating that the ability of conventional systems to predict relative survival of randomly selected pairs of patients was generally no better than chance. We developed a novel nomogram based on patient age, serum α-fetoprotein level, operative blood loss, resection margin status, tumor size, satellite lesions, and vascular invasion. The nomogram demonstrated a markedly superior concordance index of 0.74 (95% CI, 0.68 to 0.80). A separate nomogram for prediction of recurrence-free survival was also generated. Conclusions: Contemporary staging systems for HCC do not accurately predict postoperative outcomes. Our prognostic nomogram provides a mechanism for accurate prediction of survival and risk stratification and will require validation at other hepatobiliary centers. © 2008 American College of Surgeons.
Keywords: adult; cancer survival; aged; aged, 80 and over; middle aged; cancer surgery; survival rate; major clinical study; cancer recurrence; liver cell carcinoma; carcinoma, hepatocellular; liver neoplasms; cancer staging; follow up; neoplasm staging; reproducibility of results; cohort studies; tumor volume; bleeding; age factors; age; cancer invasion; confidence interval; nomograms; predictive value of tests; hepatectomy; nomogram; alpha fetoprotein; harrel concordance index; alpha-fetoproteins
Journal Title: Journal of the American College of Surgeons
Volume: 206
Issue: 2
ISSN: 1072-7515
Publisher: Elsevier Science, Inc.  
Date Published: 2008-02-01
Start Page: 281
End Page: 291
Language: English
DOI: 10.1016/j.jamcollsurg.2007.07.031
PUBMED: 18222381
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 19" - "Export Date: 17 November 2011" - "CODEN: JACSE" - "Source: Scopus"
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Citation Impact
MSK Authors
  1. Clifford Cho
    1 Cho
  2. Leslie H Blumgart
    351 Blumgart
  3. Ronald P DeMatteo
    635 DeMatteo
  4. Mithat Gonen
    832 Gonen
  5. David S Klimstra
    948 Klimstra
  6. Jinru Shia
    583 Shia
  7. William R Jarnagin
    690 Jarnagin