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Albumin‐bilirubin grade‐based nomogram of the BCLC system for personalized prognostic prediction in hepatocellular carcinoma
Author(s) -
Ho ShuYein,
Hsu ChiaYang,
Liu PoHong,
Hsia ChengYuan,
Lei HaoJan,
Huang YiHsiang,
Ko ChihChieh,
Su ChienWei,
Lee RheunChuan,
Hou MingChih,
Huo TehIa
Publication year - 2020
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.14249
Subject(s) - nomogram , medicine , hepatocellular carcinoma , proportional hazards model , confidence interval , concordance , cohort , oncology , multivariate analysis , liver cancer
Background & Aims The prognostic accuracy of individual hepatocellular carcinoma (HCC) patient in each Barcelona Clinic Liver Cancer (BCLC) stage is unclear. We aimed to develop and validate an albumin‐bilirubin (ALBI) grade‐based nomogram of BCLC to estimate survival for individual HCC patient. Methods Between 2002 and 2016, 3690 patients with newly diagnosed HCC were prospectively enrolled and retrospectively analysed. Patients were randomly split into derivation and validation cohort by 1:1 ratio. Multivariate Cox proportional hazards model was used to generate the nomogram from tumour burden, ALBI grade and performance status (PS). The concordance index and calibration plot were determined to evaluate the performance of this nomogram. Results Beta coefficients from the Cox model were used to assign nomogram points to different degrees of tumour burden, ALBI grade and PS. The scores of the nomogram ranged from 0 to 24, and were used to predict 3‐ and 5‐year patient survival. The concordance index of this nomogram was 0.77 (95% confidence interval [CI]: 0.71‐0.81) in the derivation cohort and 0.76 (95% CI: 0.71‐0.81) in the validation cohort. The calibration plots to predict both 3‐ and 5‐year survival rate well matched with the 45‐degree ideal line for both cohorts, except for ALBI‐based BCLC stage 0 in the validation cohort. Conclusions The proposed ALBI‐based nomogram of BCLC system is a simple and feasible strategy in the precision medicine era. Our data indicate it is a straightforward and user‐friendly prognostic tool to estimate the survival of individual HCC patient except for very early stage patients.