Nomogram For Prophylactic Transarterial Chemoembolization After Resection For Patients With Hepatocellular Carcinoma

Background and Aim: The aim of this study was to establish a postoperative prediction model to assess the effect of postoperative prophylactic transarterial chemoembolization(TACE).Methods: 1343 patients with HCC undergoing R0 surgical treatment between2013 and 2015 in the primary liver cancer big data were included in this study.Patients treated with surgery alone from 2013 to 2014 were randomly and averagely assigned to the training cohort and validation cohort.Univariate and multivariate analysis of the overall survival was conducted with the training cohort,and the Nomogram was constructed with the independent poor prognostic factors in the multivariate analysis.The prediction performance was tested by the concordance index(C-index)and the calibration curve in training and validation cohorts.Moreover,risk stratification was conducted in the training cohort,and the overall survival and disease-free survival was tested in the low-risk,moderate-risk and high-risk group in training and validation cohort.While the external group,which was established to evaluated the prognosis effect of postoperative TACE,was constituted by patients treated with surgery alone or assisted postoperative TACE in 2015,and postoperative TACE was assessed in the external cohort base on the risk stratification.Results: 1343 patients received R0 resection were included in this study,including 372 patients in the training group and 372 patients the validation group,and599 in the external group.According to the result of multivariate analysis,NLR level(HR=1.80,95%CI(1.27-2.56),P=0.001),AFP level(HR=1.94,95% CI(1.38-2.75),P<0.001),tumor diameter(HR=1.09,95% CI(1.04-1.13),P<0.001),MVI(HR=1.48,95% CI(1.01-2.17),P=0.043)were found as independent risk factors of overall survival and were included in the prediction model.The C-index of the training group was 0.703,the C-index of the validation group was 0.669.It is found that the standard curve and the virtual curve fit well in both training cohort and validation cohort.After the risk stratification was conducted in the training cohort,patients who got a score below 20 was defined as low-risk group,while patients who got a score higher than120 was defined as high-risk group,and others were defined as intermediate-risk group.Postoperative TACE was assessed in external cohort with the risk stratification of patients,the result showed that patients in the high-risk group can benefit from postoperative TACE of the overall survival,while the low and intermediate-risk group can’t benefit from it.Conclusions: 1.A simple and practical postoperative prediction model was established for HCC.2.The prognosis effect of postoperative prophylactic TACE was confirmed in the high-risk patients according to the model.Further research was needed to confirm the conclusion.