Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 28, 2023; 29(20): 3168-3184
Published online May 28, 2023. doi: 10.3748/wjg.v29.i20.3168
Inflammation-related nomogram for predicting survival of patients with unresectable hepatocellular carcinoma received conversion therapy
Jia-Lin Wu, Jun-Yang Luo, Zai-Bo Jiang, Si-Bo Huang, Ge-Run Chen, Hui-Ying Ran, Qi-Yue Liang, Ming-Sheng Huang, Li-Sha Lai, Jun-Wei Chen
Jia-Lin Wu, Jun-Yang Luo, Zai-Bo Jiang, Ming-Sheng Huang, Jun-Wei Chen, Department of Interventional Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
Si-Bo Huang, Ge-Run Chen, The First Clinical Medical College, Guangdong Medical University, Zhanjiang 524000, Guangdong Province, China
Hui-Ying Ran, Qi-Yue Liang, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China
Li-Sha Lai, Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou 510010, Guangdong Province, China
Author contributions: Jiang ZB, Chen JW, and Huang MS contributed to conceptualization; Wu JL, Huang SB, Chen GR, Ran HY, and Liang QY contributed to acquisition of data, formal analysis (statistics), and visualization; Wu JL and Luo JY contributed to writing-original draft; Chen JW contributed to writing-review and editing; Huang MS, Jiang ZB, Lai LS, and Chen JW contributed to supervision; and all authors read and approved the final version of the manuscript.
Supported by the National Natural Science Foundation of China, No. 82072035; and Science and Guangzhou Planned Project of Science and Technology, No. 202102010028.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of Ethical Committee of the Third Affiliated Hospital of Sun Yat-sen University (approval No. II2023-027-11).
Informed consent statement: Written informed consent of the patients was waived because of the retrospective nature of this study.
Conflict-of-interest statement: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Data sharing statement: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jun-Wei Chen, MD, Professor, Interventional Radiologist, Department of Interventional Radiology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou 510630, Guangdong Province, China. chenjw53@mail.sysu.edu.cn
Received: March 3, 2023
Peer-review started: March 3, 2023
First decision: March 24, 2023
Revised: April 2, 2023
Accepted: April 24, 2023
Article in press: April 24, 2023
Published online: May 28, 2023
Processing time: 84 Days and 0.5 Hours
Abstract
BACKGROUND

The efficacy of conversion therapy for patients with unresectable hepatocellular carcinoma (HCC) is a common clinical concern.

AIM

To analyse the prognostic factors of overall survival (OS) in patients with unresectable HCC who received conversion therapy.

METHODS

One hundred and fifty patients who met the inclusion criteria were enrolled and divided into a training cohort (n = 120) and a validation cohort (n = 30). Using the independent risk factors in the training cohort, a nomogram model was constructed to predict OS for patients treated with transarterial chemoembolization following hepatic resection. The nomogram was internally validated with the bootstrapping method. The predictive performance of nomogram was assessed by Harrell’s concordance index (C-index), calibration plot and time-dependent receiver operating characteristic curves and compared with six other conventional HCC staging systems.

RESULTS

Multivariate Cox analysis identified that albumin, blood urea nitrogen, gamma-glutamyl transpeptidase to platelet ratio, platelet to lymphocyte ratio, macrovascular invasion and tumour number were the six independent prognostic factors correlated with OS in nomogram model. The C-index in the training cohort and validation cohort were 0.752 and 0.807 for predicting OS, which were higher than those of the six conventional HCC staging systems (0.563 to 0.715 for the training cohort and 0.458 to 0.571 for the validation cohort). The calibration plots showed good consistency between the nomogram prediction of OS and the actual observations of OS. Decision curve analyses indicated satisfactory clinical utility. With a total nomogram score of 196, patients were accurately classified into low-risk and high-risk groups. Furthermore, we have deployed the model into online calculators that can be accessed for free at https://ctmodelforunresectablehcc.shinyapps.io/DynNomapp/.

CONCLUSION

The nomogram achieved optimal individualized prognostication of OS in HCC patients who received conversion therapy, which could be a useful clinical tool to help guide postoperative personalized interventions and prognosis judgement.

Keywords: Hepatocellular carcinoma; Conversion therapy; Nomogram; Inflammation; Transarterial chemoembolization

Core Tip: We developed and validated a prognostic nomogram based on inflammation-related biomarkers for patients with unresectable hepatocellular carcinoma after conversion therapy. The proposed conversion therapy model shows increased accuracy, good clinical utility, and better prognostic performance compared with conventional staging systems. Based on the total predictive risk scores, the patients were classified into two groups: low-risk (score < 196) and high-risk group (score ≥ 196), to guide postoperative adjuvant interventions and follow-ups. Furthermore, we have made this prognostic nomogram online for free use (https://ctmodelforunresectablehcc.shinyapps.io/DynNomapp/).