Radiotherapy Value Of Huge Hepatocellular Carcinoma And Development Of Prognostic Nomogram

ObjectiveHuge hepatocellular carcinoma(huge HCC,diameter≥10cm)has poor prognosis and high recurrence rate.Currently,there is no consensus on the treatment strategy of huge HCC.This study aims to analyze clinicopathological factors that affect the prognosis of patients with huge HCC,evaluate the prognostic value of radiotherapy for huge HCC,and establish a nomogram predictive model for survival analysis.MethodsA total of 2328 patients with huge HCC were identified from the SEER database between 2004 and 2016.The clinicopathological data and follow-up information were collected,and the Propensity score matching(PSM)was conducted to reduce selection bias.Univariate and multivariate Cox regression analysis were performed to analyze the independent prognostic factors affecting overall survival(OS)and cancer-specific survival(CSS).Forest plot was used to show the subgroup analysis results.Prognostic analysis was performed by Kaplan-Meier method,and survival curves were drawn.Patients from SEER database were randomly divided into modeling group and internal validation group(7:3),and 115 patients with huge HCC were collected from our hospital as external validation group.A prognostic nomogram was established,and the predictive accuracy and discriminative ability were evaluated by concordance index(C-index),calibration curve,ROC curve and decision curve.SPSS 22.0 and R 3.6.1 software were used for statistical analysis.ResultsAfter 1:4 propensity-score matching,univariate and multivariate Cox analysis suggested that age≧60 years,AFP above normal,poor tumor differentiation,higher T stage,distant metastasis were independent risk factors for both OS and CSS,and chemotherapy(HR = 0.517,P < 0.001),surgery(HR0.296,P < 0.001),radiotherapy(HR=0.572,P < 0.001)were independent protective factors for both OS and CSS.Logrank analysis showed that radiotherapy group had a superiority in terms of OS(P < 0.001)and CSS(P < 0.001).The 1-,3-,and 5-year OS of radiotherapy and non-radiotherapy group were 42.1% vs.29,5%;17.6% vs.13.6%;and 10.2% vs.8.7%,respectively.The median OS of radiotherapy and non-radiotherapy group were 10 months vs.6 months.Subgroup analyses showed that radiotherapy conferred significantly improved CSS and OS for non-operated huge HCC patients.The above 8 independent prognostic factors were incorporated into the nomogram.The C-index of modeling cohort,internal validation cohort and external validation cohort was 0.751(95%CI:0.74-0.76),0.753(95%CI:0.73-0.77),and 0.708(95%CI:0.61-0.80),the AUC was 75.6%,77.2%,and 68.2%.The calibration curve and decision curve show great prediction consistency and better predictive power than TNM stage.ConclusionsAge,AFP,grade,T stage,M stage,chemotherapy,surgery and radiotherapy are independent prognostic factors of OS and CSS in huge HCC patients.Radiotherapy provided survival benefits for huge HCC patients,especially those without surgery.A Nomogram was established based on SEER database our hospital data for predicting the prognosis of patients with huge HCC.