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Research article
Shi-yao Chen
Zhongshan Hospital Fudan University
Corresponding Author
ORCiD: https://orcid.org/0000-0002-7276-1998
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Background To investigate prognostic value of varying degrees of liver fibrosis in hepatocellular carcinoma (HCC) patients and establish an effective prognostic nomogram. Methods Eligible HCC patients with different degrees of fibrosis between 2004 and 2015 were matched from the Surveillance, Epidemiology, and End Results (SEER) database using propensity score matching (PSM). Prognostic value was evaluated using Kaplan-Meier and Cox hazard analysis. The nomogram on variables selected by multivariate analyses was established and subjected to internal validation. The predictive accuracy of nomograms was tested by concordance index (C-index) and calibration. Results HCC patients with advanced fibrosis/ cirrhosis was correlated with poor survival than those with none/moderate fibrosis in all patients HR: 1.111, 95%CI (1.042-1.185); p=0.001 and in the PSM cohort HR: 1.131, 95%CI (1.032-1.240); p=0.009. Multivariate analysis of propensity-matched cohort revealed that age more than 63, higher fibrosis score, AJCC stage T3-4, distant metastasis (M1), Tumor size ≥1, vascular invasion and elevated AFP level were independent factors. The nomogram integrating these factors offers an effective prognostic prediction for HCC patients (C-index 0.749, 95%CI: 0.735~0.763) relative to AJCC 7th edition (0.727) and TNM (0.73). The calibration plots suggested optimal agreement between nomogram prediction and actual observation. Conclusions Increased fibrosis was an independent risk factor for HCC survival. The prognostic nomogram integrating fibrosis score offers a more accurate prediction.
Keywords
Liver fibrosis, Hepatocellular carcinoma, Nomogram, Prognosis
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This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Research article
Shi-yao Chen
Zhongshan Hospital Fudan University
Corresponding Author
ORCiD: https://orcid.org/0000-0002-7276-1998
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
Version 1
Posted 20 Nov, 2019
No community comments so far
Metrics
Comments: 0
PDF Downloads: ...
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License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background To investigate prognostic value of varying degrees of liver fibrosis in hepatocellular carcinoma (HCC) patients and establish an effective prognostic nomogram. Methods Eligible HCC patients with different degrees of fibrosis between 2004 and 2015 were matched from the Surveillance, Epidemiology, and End Results (SEER) database using propensity score matching (PSM). Prognostic value was evaluated using Kaplan-Meier and Cox hazard analysis. The nomogram on variables selected by multivariate analyses was established and subjected to internal validation. The predictive accuracy of nomograms was tested by concordance index (C-index) and calibration. Results HCC patients with advanced fibrosis/ cirrhosis was correlated with poor survival than those with none/moderate fibrosis in all patients HR: 1.111, 95%CI (1.042-1.185); p=0.001 and in the PSM cohort HR: 1.131, 95%CI (1.032-1.240); p=0.009. Multivariate analysis of propensity-matched cohort revealed that age more than 63, higher fibrosis score, AJCC stage T3-4, distant metastasis (M1), Tumor size ≥1, vascular invasion and elevated AFP level were independent factors. The nomogram integrating these factors offers an effective prognostic prediction for HCC patients (C-index 0.749, 95%CI: 0.735~0.763) relative to AJCC 7th edition (0.727) and TNM (0.73). The calibration plots suggested optimal agreement between nomogram prediction and actual observation. Conclusions Increased fibrosis was an independent risk factor for HCC survival. The prognostic nomogram integrating fibrosis score offers a more accurate prediction.
Figure 1
Figure 2
Figure 3
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