Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Dec 15, 2024; 16(12): 4650-4662
Published online Dec 15, 2024. doi: 10.4251/wjgo.v16.i12.4650
Nomogram model based on γ-glutamyl transferase to albumin ratio predicts survival in hepatocellular carcinoma patients with transarterial chemoembolization treatment
Zhen-Ying Wu, Han Li, Jia-Li Chen, Ke Su, Mei-Ling Weng, Yun-Wei Han
Zhen-Ying Wu, Han Li, Jia-Li Chen, Mei-Ling Weng, Yun-Wei Han, Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
Zhen-Ying Wu, Department of Oncology, Pangang Group General Hospital, Panzhihua 617000, Sichuan Province, China
Ke Su, Department of Oncology, National Cancer Center, Beijing 100000, China
Ke Su, Department of Oncology, National Clinical Research Center for Cancer, Beijing 100000, China
Ke Su, Department of Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100000, China
Co-first authors: Zhen-Ying Wu and Han Li.
Author contributions: Wu ZY, Li H, and Han YW conceived, designed and refined the study protocol; Chen JL, Su K, and Weng ML were involved in the data collection and formulation of research objectives; Wu ZY and Li H drafted the manuscript; and all authors were involved in the critical review of the results and approved the final manuscript. Wu ZY and Li H contributed equally to this work. The reasons for designating Wu ZY and Li H as co-first authors are threefold. First, the research was performed as a collaborative effort, and the designation of co-first authorship accurately reflects the distribution of responsibilities and burdens associated with the time and effort required to complete the study and the resultant paper. This also ensures effective communication and management of post-submission matters, ultimately enhancing the paper’s quality and reliability. Second, the overall research team encompassed authors with a variety of expertise and skills from different fields, and the designation of co-first authors best reflect this diversity. This also promotes the most comprehensive and in-depth examination of the research topic, ultimately enriching readers’ understanding by offering various expert perspectives. Third, Wu ZY and Li H contributed efforts of equal substance throughout the research process. They equally made a significant contribution to the work reported, in the design of methodology, creation of models, testing of code, statistical analysis, validation of results, writing the initial draft, and revision of articles. The choice of these researchers as co-first authors acknowledge and respects this equal contribution, while recognizing the spirit of teamwork and collaboration of this study. In summary, we believe that designating Wu ZY and Li H as co-first authors of are fitting for our manuscript as it accurately reflects our team’s collaborative spirit, equal contributions, and diversity.
Institutional review board statement: The study protocol was authorized by the Ethics Committee of the Affiliated Hospital of Southwest Medical University (No. KY2021063) and complied with the Code of Ethics of the World Medical Association.
Informed consent statement: Written informed consent was waived because of the retrospective study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: All data generated or analyzed during this study are included in this article and its Supplementary material files. Further inquiries can be directed to the corresponding author (lanpaoxiansheng@126.com).
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: Yun-Wei Han, MD, PhD, Academic Research, Full Professor, Department of Oncology, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Jiangyang District, Luzhou 646000, Sichuan Province, China. lanpaoxiansheng@126.com
Received: June 13, 2024
Revised: September 16, 2024
Accepted: October 11, 2024
Published online: December 15, 2024
Processing time: 152 Days and 4.4 Hours
Abstract
BACKGROUND

The development of tumor is closely linked to inflammation. Therefore, targeting molecules involved in inflammation may be effective in predicting cancer prognosis. Transarterial chemoembolization (TACE) holds significant therapeutic significance in addressing hepatocellular carcinoma (HCC). At present, no studies have evaluated the predictive value of γ-glutamyl transferase to albumin ratio (GAR) on the prognosis of HCC undergoing TACE.

AIM

To explore the potential prognostic significance of the GAR in individuals undergoing TACE for HCC.

METHODS

A total of 1231 patients from seven hospitals in China were randomized into a training cohort (n = 862) and a validation cohort (n = 369). To establish independent prognostic factors for overall survival (OS), we utilized multivariate and univariate Cox regression models. The best cut-off value of the GAR was determined with the X-tile software, with OS as the basis. Validations were performed using dual therapy cohort and triple therapy cohort.

RESULTS

X-tile software revealed a GAR threshold of 4.75 as optimal. Both pre- and post-propensity score matching analyses demonstrated that the median OS in the low-GAR group (< 4.75) was notably longer compared to the high-GAR group (≥ 4.75), showing results of 26.9 vs 9.8 months (P < 0.001) initially, and 18.1 vs 11.3 months (P < 0.001) after match. Furthermore, multivariate analysis identified GAR ≥ 4.75 as an independent prognostic factor (P < 0.001). The receiver operating characteristic curves for the nomogram showed area under receiver operating characteristic curves of 0.741, 0.747, and 0.708 for predicting 1-, 2-, and 3-year survival, respectively. Consistent findings were reiterated in the two cohorts involving TACE in combination with targeted therapy and TACE in combination with targeted therapy and immunotherapy. Calibration curve and decision curve analyses substantiated the model’s relatively robust predictive capabilities.

CONCLUSION

Our study validates the effective prognostic capacity of the GAR-based nomogram for HCC patients undergoing TACE or TACE in combination with systemic therapy.

Keywords: Transarterial chemoembolization; Immunotherapy; Targeted therapy; Hepatocellular carcinoma; Prognosis

Core Tip: γ-glutamyl transferase to albumin ratio has been confirmed for the first time to be predictive in hepatocellular carcinoma undergoing transarterial chemoembolization and transarterial chemoembolization combined with systemic therapy in this large-sample multicenter study. A nomogram model for predicting postoperative survival was also established based on γ-glutamyl transferase to albumin ratio, which was empirically demonstrated to have strong predictive ability.