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Surgery Today
Published in: Surgery Today 6/2019

01-06-2019 | Hepatocellular Carcinoma | Original Article

Validated nomogram for the prediction of disease-free survival after hepatectomy for hepatocellular carcinoma within the Milan criteria: individualizing a surveillance strategy

Authors: Ka Wing Ma, Wong Hoi She, Tan To Cheung, Albert Chi Yan Chan, Wing Chiu Dai, James Yan Yue Fung, Chung Mau Lo, Kenneth Siu Ho Chok

Published in: Surgery Today | Issue 6/2019

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Abstract

Objective

We sought to develop a nomogram for the prediction of tumor recurrence after resection of hepatocellular carcinoma (HCC) within the Milan criteria.

Method

Consecutive HCC patients admitted for hepatectomy between 1994 and 2014 were enrolled in this study. Patients were excluded if they had recurrent HCC or tumors beyond the Milan criteria. Patients were randomized and assigned to the derivation and validation sets in a 1:1 ratio. Independent factors for disease-free survival were identified using the Cox regression model. A nomogram was derived and validated with the receiver-operating characteristic (ROC) and calibration curves.

Results

There were 617 eligible patients included in the analysis. The median age was 59 years, 481 were male, and 87.8% of the patients were hepatitis B virus carriers. The median follow-up was 68.7 months. The 5-year overall survival rate was 73.3% and HCC recurrence was detected in 55% of the patients. In the derivation set, a nomogram was constructed based on the seven independent factors for disease-free survival: age, alpha-fetoprotein, preoperative prothrombin time, magnitude of hepatectomy, postoperative complication, number of tumor nodules, and presence of microvascular invasion. A satisfactory discrimination ability was observed in both the derivation and validation sets (c-stat 0.672 and 0.665, respectively). The calibration plot yielded agreement between the predicted and observed outcomes, using the derived nomogram.

Conclusion

A validated nomogram quantifies the risk of recurrence after hepatectomy for HCC within the Milan criteria, and assists with the planning of individual postoperative surveillance protocols.
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Metadata
Title
Validated nomogram for the prediction of disease-free survival after hepatectomy for hepatocellular carcinoma within the Milan criteria: individualizing a surveillance strategy
Authors
Ka Wing Ma
Wong Hoi She
Tan To Cheung
Albert Chi Yan Chan
Wing Chiu Dai
James Yan Yue Fung
Chung Mau Lo
Kenneth Siu Ho Chok
Publication date
01-06-2019
Publisher
Springer Singapore
Published in
Surgery Today / Issue 6/2019
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-019-1764-x

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