A New Treatment-integrated Prognostic Nomogram of the Barcelona Clinic Liver Cancer System for Hepatocellular Carcinoma

• Published in: Scientific reports 2017-08, Vol.7 (1), p.7914-10, Article 7914
• Main Authors: Hsu, Chia-Yang, Liu, Po-Hong, Hsia, Cheng-Yuan, Lee, Yun-Hsuan, Nagaria, Teddy S., Lee, Rheun-Chuan, Ho, Shu-Yein, Hou, Ming-Chih, Huo, Teh-Ia
• Format: Article
• Language: English
• Subjects: 631/67/1504/1610/4029; 631/67/70; Aged; Aged, 80 and over; Cancer therapies; Carcinoma, Hepatocellular - diagnosis; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - therapy; Cirrhosis; Female; Hepatocellular carcinoma; Humanities and Social Sciences; Humans; Liver cancer; Liver cirrhosis; Liver Neoplasms - diagnosis; Liver Neoplasms - pathology; Liver Neoplasms - therapy; Male; Middle Aged; multidisciplinary; Neoplasm Staging; Nomograms; Performance evaluation; Prognosis; Science; Science (multidisciplinary)
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-017-08382-3

The nomogram of the Barcelona Clinic Liver Cancer (BCLC) has accurate outcome prediction. This study aims to propose a treatment-integrated nomogram derived from BCLC for patients with hepatocellular carcinoma (HCC). A total of 3,371 patients were randomly grouped into derivation (n = 2,247) and validation (n = 1,124) sets. Multivariate Cox proportional hazards model was used to generate the nomogram from tumor burden, cirrhosis, performance status (PS) and primary anti-cancer treatments. Concordance indices and calibration plots were used to evaluate the performance of nomogram. The derivation and validation sets had the same concordance index of 0.774 (95% confidence intervals: 0.717–0.826 and 0.656–0.874, respectively). In calibration plots, survival distributions predicted by the nomogram and observed by the Kaplan-Meier method were similar at 3- and 5-year for patients from derivation and validation sets. Validation group patients divided into 10 subgroups by the original and new treatment-integrated BCLC nomogram were used to evaluate the prognostic performance of integrating primary anti-cancer treatments. Compared to the nomogram of original BCLC system, the treatment-integrated nomogram of BCLC system had larger linear trend and likelihood ratio X 2 . In conclusion, based on the results of concordance index tests, integrating primary anti-cancer treatments into the BCLC system provides similar discriminatory ability.