Guido Torzilli1, Matteo Donadon2, Jacques Belghiti3, Norihiro Kokudo4, Tadatoshi Takayama5, Alessandro Ferrero6, Gennaro Nuzzo7, Jean-Nicolas Vauthey8, Michael A Choti9, Eduardo De Santibanes10, Masatoshi Makuuchi11. 1. Department of Hepatobiliary and General Surgery, Humanitas University, Humanitas Research Hospital IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy. guido.torzilli@humanitas.it. 2. Department of Hepatobiliary and General Surgery, Humanitas University, Humanitas Research Hospital IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy. 3. Service de Chirurgie Hepatique et Pancreatique, Hospital Beaujon, University of Paris VII, Clichy Cedex, Paris, France. 4. Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. 5. Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan. 6. Department HPB and Digestive Surgery, Ospedale Mauriziano Umberto I, Turin, Italy. 7. Department of Surgery, Hepatobiliary Surgery Unit, Catholic University of the Sacred Heart, School of Medicine, Rome, Italy. 8. Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA. 9. Department of Surgery and Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA. 10. General Surgery and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Gascon, Buenos Aires, Argentina. 11. Japanese Red Cross Medical Center, Tokyo, Japan.
Abstract
INTRODUCTIONS: Different staging systems have been devised for patients undergoing resection for hepatocellular carcinoma (HCC) with disparate results. The aim of this study was to create a new nomogram to predict individual survival after hepatectomy for HCC. METHODS: Based on the "Hepatocellular Carcinoma: Eastern & Western Experiences Network," data from 2046 patients who underwent HCC resections at ten centers were reviewed. Patient survival was analyzed with Cox-regression analysis to construct a unique nomogram and contour plots to predict survival. RESULTS: The nomograms built on the multivariate analyses, which showed that the independent predictors were tumor size, tumor number, vascular invasion, cirrhosis, preoperative bilirubin value, and esophageal varices, showed good calibration and discriminatory abilities with C-index value of 0.62 (95 % CI, 0.59-0.69) and 0.61 (95 % CI, 0.56-0.64) for overall and disease-free survival, respectively. The 5-year survival contour plots showed that the presence of vascular invasion was associated with decreased survival, regardless of the tumor number or size. Cirrhosis and varices were equally associated with decreased survival, according to the tumor number or size. CONCLUSIONS: These nomograms accurately predict individual prognosis after HCC resection and support an expansion of the selection criteria for resection. They offer useful guidance to clinicians for individual survival prediction.
INTRODUCTIONS: Different staging systems have been devised for patients undergoing resection for hepatocellular carcinoma (HCC) with disparate results. The aim of this study was to create a new nomogram to predict individual survival after hepatectomy for HCC. METHODS: Based on the "Hepatocellular Carcinoma: Eastern & Western Experiences Network," data from 2046 patients who underwent HCC resections at ten centers were reviewed. Patient survival was analyzed with Cox-regression analysis to construct a unique nomogram and contour plots to predict survival. RESULTS: The nomograms built on the multivariate analyses, which showed that the independent predictors were tumor size, tumor number, vascular invasion, cirrhosis, preoperative bilirubin value, and esophageal varices, showed good calibration and discriminatory abilities with C-index value of 0.62 (95 % CI, 0.59-0.69) and 0.61 (95 % CI, 0.56-0.64) for overall and disease-free survival, respectively. The 5-year survival contour plots showed that the presence of vascular invasion was associated with decreased survival, regardless of the tumor number or size. Cirrhosis and varices were equally associated with decreased survival, according to the tumor number or size. CONCLUSIONS: These nomograms accurately predict individual prognosis after HCC resection and support an expansion of the selection criteria for resection. They offer useful guidance to clinicians for individual survival prediction.
Authors: J M Llovet; J Bustamante; A Castells; R Vilana; M del C Ayuso; M Sala; C Brú; J Rodés; J Bruix Journal: Hepatology Date: 1999-01 Impact factor: 17.425
Authors: Yujin Hoshida; Augusto Villanueva; Masahiro Kobayashi; Judit Peix; Derek Y Chiang; Amy Camargo; Supriya Gupta; Jamie Moore; Matthew J Wrobel; Jim Lerner; Michael Reich; Jennifer A Chan; Jonathan N Glickman; Kenji Ikeda; Masaji Hashimoto; Goro Watanabe; Maria G Daidone; Sasan Roayaie; Myron Schwartz; Swan Thung; Helga B Salvesen; Stacey Gabriel; Vincenzo Mazzaferro; Jordi Bruix; Scott L Friedman; Hiromitsu Kumada; Josep M Llovet; Todd R Golub Journal: N Engl J Med Date: 2008-10-15 Impact factor: 91.245
Authors: Clifford S Cho; Mithat Gonen; Jinru Shia; Michael W Kattan; David S Klimstra; William R Jarnagin; Michael I D'Angelica; Leslie H Blumgart; Ronald P DeMatteo Journal: J Am Coll Surg Date: 2007-10-29 Impact factor: 6.113