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Development and Validation of Pre- and Post-Operative Models to Predict Recurrence After Resection of Solitary Hepatocellular Carcinoma: A Multi-Institutional Study

Authors Wu MY, Qiao Q, Wang K, Ji GW, Cai B, Li XC

Received 26 February 2020

Accepted for publication 19 April 2020

Published 15 May 2020 Volume 2020:12 Pages 3503—3512


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Harikrishna Nakshatri

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 work

Correspondence: Xiang-Cheng Li
Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, People’s Republic of China
Tel +86 18951999088
Fax +86 2568136450
Bing Cai
Department of Hepatobiliary Surgery, Wuxi People’s Hospital, 299 Qingyang Road, Wuxi 214023, People’s Republic of China
Tel +86 13358112071
Fax +86 51082700778

Background: 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

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