Nomogram for Predicting Long-Term Survival after Synchronous Resection for Hepatocellular Carcinoma and Inferior Vena Cava Tumor Thrombosis: A Multicenter Retrospective Study

Yannan Bai; Jiayi Wu; Yong Zeng; Jie Chen; Shuangjia Wang; Shi Chen; Funan Qiu; Songqiang Zhou; Shen You; Yifeng Tian; Yaodong Wang; Maolin Yan

doi:10.1155/2020/3264079

Nomogram for Predicting Long-Term Survival after Synchronous Resection for Hepatocellular Carcinoma and Inferior Vena Cava Tumor Thrombosis: A Multicenter Retrospective Study

J Oncol. 2020 Apr 8:2020:3264079. doi: 10.1155/2020/3264079. eCollection 2020.

Authors

Yannan Bai¹, Jiayi Wu¹, Yong Zeng², Jie Chen³, Shuangjia Wang⁴, Shi Chen¹, Funan Qiu¹, Songqiang Zhou¹, Shen You¹, Yifeng Tian¹, Yaodong Wang¹, Maolin Yan¹

Affiliations

¹ Department of Hepatobiliary Surgery, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou 350001, China.
² Department of Hepatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.
³ Department of Hepatic Surgery, Sun Yet-sen Memorial Hospital, Sun Yet-sen University, Guangzhou 510120, China.
⁴ Department of Hepatobiliary & Pancreatovascular Surgery, First Affiliated Hospital of Xiamen University, Xiamen 361003, China.

Abstract

Background: Although surgery for hepatocellular carcinoma (HCC) complicated with inferior vena cava tumor thrombus (IVCTT) may improve survival for some patients, prognostic markers remain elusive because of its rarity. We constructed a prognostic nomogram which predicts individualized survival benefit of curative-intent surgery for HCC patients with IVCTT.

Methods: According to abdominothoracic anatomy of inferior vena cava (IVC), IVCTT can be divided into 3 types: inferior diaphragmic (ID), superior diaphragmic (SD), and intracardiac type (IC). Data of 64 HCC patients with IVCTT who underwent curative-intent surgery between 2008 and 2015 in four centers in China were analyzed retrospectively. Univariate and multivariate Cox regression analyses were conducted to select variables for the construction of a prognostic nomogram. Predictive accuracy and discriminative ability were examined by concordance index (C-index) and calibration curve.

Results: Of 64 patients in the IVCTT classification, 37 (57.8%) were classified as ID type, 15 (23.4%) as SD type, and 12 (18.8%) as IC type. The 1-, 2-, 3-, and 5-year disease-specific survival (DSS) rates for patients in ID, SD, and IC groups were 94.4%, 55.6%, 71.4%, and 30.0%; 27.8%, 21.4%, 7.1%, and 0%; and 8.3%, 0%, 0%, and 0%, respectively. Independent factors included in the nomogram were ECOG performance status, AFP level ≥ 400 μg/L, tumor size ≥ 10 cm, portal vein tumor thrombosis, and IVCTT classification. The C-index of the nomogram was 0.812 (95% CI 0.761-0.873). The calibration plot for DSS probability showed excellent agreement between the prediction by nomogram and actual observation.

Conclusions: Curative-intent surgery should be carefully evaluated and suggested according to our novel IVCTT classification. We have developed a visual web-based nomogram model to predict oncological prognosis of curative-intent surgery for HCC patients with IVCTT.