Observational Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Aug 27, 2024; 16(8): 2630-2639
Published online Aug 27, 2024. doi: 10.4240/wjgs.v16.i8.2630
Nomogram predicting the prognosis of primary liver cancer after radiofrequency ablation combined with transcatheter arterial chemoembolization
Hai-Hua Shen, Yu-Rong Hong, Wen Xu, Lei Chen, Jun-Min Chen, Zhi-Gen Yang, Cai-Hong Chen
Hai-Hua Shen, Lei Chen, Jun-Min Chen, Zhi-Gen Yang, Department of Ultrasound, Hangzhou Linping Hospital of Traditional Chinese Medicine, Hangzhou 311106, Zhejiang Province, China
Yu-Rong Hong, Wen Xu, Department of Ultrasound, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
Cai-Hong Chen, Department of Nursing, Hangzhou Linping Hospital of Traditional Chinese Medicine, Hangzhou 311106, Zhejiang Province, China
Author contributions: Shen HH conducted the study and wrote the paper; Hong YR and Xu W designed the study and supervised the report; Chen L and Chen JM contributed to the analysis; Yang ZG collected clinical data; Chen CH designed the study and provided administrative support; and all authors have approved the manuscript.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Hangzhou Linping Hospital of Traditional Chinese Medicine.
Informed consent statement: This study was approved by the Ethics Committee of the Hangzhou Linping Hospital of Traditional Chinese Medicine for exemption from informed consent.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: The datasets used in this study were obtained from the corresponding author.
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: Cai-Hong Chen, BSc, Associate Chief Nurse, Department of Nursing, Hangzhou Linping Hospital of Traditional Chinese Medicine, No. 101 Yuncheng Street, Tangqi Town, Linping District, Hangzhou 311106, Zhejiang Province, China. chencaihong1982@163.com
Received: April 1, 2024
Revised: May 22, 2024
Accepted: July 11, 2024
Published online: August 27, 2024
Processing time: 137 Days and 1.6 Hours
Abstract
BACKGROUND

The incidence and mortality rates of primary hepatocellular carcinoma (HCC) are high, and the conventional treatment is radiofrequency ablation (RFA) with transcatheter arterial chemoembolization (TACE); however, the 3-year survival rate is still low. Further, there are no visual methods to effectively predict their prognosis.

AIM

To explore the factors influencing the prognosis of HCC after RFA and TACE and develop a nomogram prediction model.

METHODS

Clinical and follow-up information of 150 patients with HCC treated using RFA and TACE in the Hangzhou Linping Hospital of Traditional Chinese Medicine from May 2020 to December 2022 was retrospectively collected and recorded. We examined their prognostic factors using multivariate logistic regression and created a nomogram prognosis prediction model using the R software (version 4.1.2). Internal verification was performed using the bootstrapping technique. The prognostic efficacy of the nomogram prediction model was evaluated using the concordance index (CI), calibration curve, and receiver operating characteristic curve.

RESULTS

Of the 150 patients treated with RFA and TACE, 92 (61.33%) developed recurrence and metastasis. Logistic regression analysis identified six variables, and a predictive model was created. The internal validation results of the model showed a CI of 0.882. The correction curve trend of the prognosis prediction model was always near the diagonal, and the mean absolute error before and after internal validation was 0.021. The area under the curve of the prediction model after internal verification was 0.882 [95% confidence interval (95%CI): 0.820-0.945], with a specificity of 0.828 and sensitivity of 0.656. According to the Hosmer-Lemeshow test, χ2 = 3.552 and P = 0.895. The predictive model demonstrated a satisfactory calibration, and the decision curve analysis demonstrated its clinical applicability.

CONCLUSION

The prognosis of patients with HCC after RFA and TACE is affected by several factors. The developed prediction model based on the influencing parameters shows a good prognosis predictive efficacy.

Keywords: Nomogram; Primary liver cancer; Radiofrequency ablation; Transcatheter arterial chemoembolization; Prognosis; Influencing factors; Decision curve analysis

Core Tip: The incidence and mortality rates of primary hepatocellular carcinoma (HCC) are alarming. Even after radiofrequency ablation (RFA) and transcatheter arterial chemoembolization (TACE), the survival rate of patients is still low. Thus, the risk of poor prognosis needs to be accurately predicted. We analyzed the clinical and follow-up data of 150 patients with HCC and solved the problem of poor prognosis assessment by explaining the relationship between the independent influencing factors of HCC and the prognosis of the patients. Subsequently, a predictive nomogram model was developed for determining the prognosis of patients with HCC after RFA and TACE.