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Nomogram of the Barcelona Clinic Liver Cancer system for individual prognostic prediction in hepatocellular carcinoma
Author(s) -
Hsu ChiaYang,
Liu PoHong,
Hsia ChengYuan,
Lee YunHsuan,
Al Juboori Alhareth,
Lee RheunChuan,
Lin HanChieh,
Huo TehIa
Publication year - 2016
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.13114
Subject(s) - nomogram , concordance , medicine , liver cancer , hepatocellular carcinoma , confidence interval , proportional hazards model , multivariate analysis , multivariate statistics , oncology , statistics , mathematics
Background & Aims The predictive accuracy of the Barcelona Clinic Liver Cancer ( BCLC ) staging system on a single patient is not clear. This study aimed to develop a nomogram to predict individualized survival of patients with hepatocellular carcinoma ( HCC ) based on the BCLC system. Methods A total of 3179 patients were randomly grouped into derivation ( n = 2119) and validation ( n = 1060) sets. The multivariate Cox proportional hazards model was used to generate the nomogram from tumour burden, cirrhosis and performance status ( PS ). The performance of the nomogram was evaluated by concordance indices and calibration tests. Results Beta coefficients from the Cox model were used to assign nomogram points to different degrees of tumour burden, Child‐Turcotte‐Pugh classification and PS . A nomogram with a scale of 0–26 was developed and the predicted survival rates at 3 and 5 years were calculated. The derivation set had a concordance index of 0.766 (95% confidence interval [ CI ]: 0.686–0.838); and the validation set showed a concordance index of 0.775 (95% CI : 0.607–0.909). The calibration plots were close to the 45‐degree line for 3‐ and 5‐year survival prediction of BCLC stages 0–C patients in both derivation and validation groups. For BCLC stage D patients, calibration plots in both groups showed deviation from the 45‐degree line for 3‐ and 5‐year prediction. Conclusions This study provides quantitative evidence to support the prognostic ability of BCLC system. This straightforward and easy‐to‐use nomogram may accurately predict the survival at 3 and 5 years for individual HCC patient except for BCLC stage D patients.