Nomogram To Predict Survival Of Patients With Recurrence Of Hepatocellular Carcinoma After Secondary Surgery

Objective: We aimed to establish and validate a nomogram to predict survival at3 and 5years after secondary hepatectomy in patients with recurrent HCC who underwent radical resection.Methods:This study was a retrospective cohort study that collected clinicopathological data of 126 patients who underwent a second radical resection for hepatocellular carcinoma in the Department of Hepatobiliary Surgery,Fujian Provincial Hospital from January 2011 to December 2018.Inclusion criteria :(1)Age ≥18 years;(2)Radical resection was performed for the first hepatocellular carcinoma,and this recurrence had the typical imaging characteristics of hepatocellular carcinoma,so radical surgical treatment was planned;(3)Radical surgical resection of the lesions evaluated by CT,MRI,PET and other imaging techniques;(4)Child-Pugh grade A or B(no or mild liver dysfunction);(5)The basic condition of heart and lung is good and can tolerate surgical treatment;(6)Primary liver cancer was not treated preoperatively,and there was no history of other malignant tumors.Exclusion criteria :(1)death within 30 days after surgery;(2)Tumor thrombus was visible to the naked eye;(3)Primary hepatocellular carcinoma with extrahepatic metastasis or hepatic vein or inferior vena cava invasion;(4)Complicated with other tumors and severe heart and lung diseases;(5)Advanced liver cancer cannot be treated by radical surgery;(6)Preoperative anti-cancer treatment,such as TACE;(7)Previous history of other tumors;(8)Postoperative nontumor-related death;(9)Incomplete clinical follow-up data.(10)No follow-up was performed within 3 months after surgery.The 126 patients were followed up after secondary surgery,The median follow-up time was 40 months.According to the clinical stage of BCLC,126 patients were divided into two groups: group A and group B with different clinical stages of HCC,and the patients with different stages of HCC were analyzed.Univariate analysis was used to analyze the relationship between age,sex,BMI,preoperative liver function indexes,tumor size and number at recurrence,alpha-fetoprotein,microvascular invasion,tumor capsule and recurrence time and Postrecurrence survival(PRS).The independent risk factors of PRS were screened out by multivariate analysis,and the prediction model of the nomogram was drawn by R software.The nomogram was based on variables independently associated with survival after HCC recurrence.We used data from the same 126 studies treated at the same institution for self-sampling validation of the nomogram,from 2011 through 2018.Results: AFP of recurrence(HR 1.84;P<0.01)、size of recurrence(HR 2.39;P<0.01) and MVI(HR 2.10 P<0.01)is the independent risk factor for post-recurrence survival(PRS),and based on this,we set up a nomogram.The C-index of the nomogram model was 0.820(95%CI,0.703-0.898)based on the receiver operating characteristic curve(ROC curve).The calibration curve also proved that the predicted results of the nomogram were highly consistent with the actual survival.Conclusion: AFP of recurrence,size of recurrence and MVI were independent risk factors for Post-recurrence survival.We established a nomogram to predict the PRS of patients after radical resection of HCC(mostly with hepatitis B virus infection)and performed self-sampling validation.