Background & Aims: Hepatocellular carcinoma (HCC) is a kind of tumor with high invasiveness, and HCC patients with metastases have a higher risk of early death. One aim of the present study was to identify the prognostic factors of early death in HCC patients with metastases and to establish predictive nomograms. The other aim was to investigate the prognostic survival effect of chemotherapy.
Methods: 3,428 HCC patients with metastases between 2010 and 2019 were extracted from the Surveillance, Epidemiology and End Results (SEER) database. Univariate and multivariate Cox regression models were applied to measure potential risk factors, and the nomogram of overall survival (OS) at different times was formulated. Propensity score matching (PSM) and Kaplan-Meier Survival Curve were further performed to evaluate the influence of chemotherapy on prognosis.
Results: Lung metastasis, Alpha-fetoprotein (AFP), tumor size, T stage, N stage, surgery, radiation and chemotherapy were independent prognostic risk factors for OS that were utilized to conduct the nomogram. In the training cohort and internal validation cohort, the C-indexes of the prediction model were 0.728 (95% confidence interval (CI): 0.722-0.734), and 0.742 (0.733-0.751). Specifically, the survival risk for HCC metastasis patients without chemotherapy was 1.935 times higher than with chemotherapy. Chemotherapy prolonged the median survival period by 3 months.
Conclusions: We constructed a new nomogram to predict OS in HCC patients with metastases, which can help patients and doctors to judge prognosis and make clinical decisions. It has been shown that in metastatic HCC patients, chemotherapy is an effective treatment option to improve prognostic survival.