Nomogram model of prognosis of hepatocellular carcinoma patients was constructed based on NRS-2002
Wang Chao, Han Shanshan, Chen Shu, Ding Shengyi, Feng Zhiqiang
2020, 7(3):
22-29.
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Objective: The nutritional risk Assessment Form (NRS-2002) was used to assess the nutritional status of patients with hepatocellular carcinoma (HCC) and to construct a Nomogram model to predict the recurrence of HCC patients in combination with other risk factors. Methods: The clinical data of 241 patients with HCC underwent hepatectomy in Suixi County People's Hospital, Beijing Chaoyang Emergency Rescue Center and Air Force Characteristic Medical Center from July 2015 to January 2019 were retrospectively analyzed. Univariate and multivariate Cox proportional risk models were used to analyze the independent risk factors for recurrence and death of HCC patients. Nomogram model was constructed according to independent risk factors.Internal data were used to verify the effectiveness of the Nomogram model. Results: ROC curve was used to analyze the correlation variables according to the mortality of HCC patients.The AUC of age, AFP, TBIL, ALT and ALB were 0.783, 0.715, 0.758, 0.729 and 0.822, respectively.The optimal truncation values were 65years、400μg/L、34.67μmol/L、40.54U/L、35g/L, respectively.The proportion of cirrhosis(yes), TBIL (>34.67μmol/L) and ALB(≤35g/L)in patients with malnutrition was higher than that in patients with normal nutrition (P<0.05).At the end of follow-up, 127 of the 241 HCC patients relapsed, with a median relapse-free survival of 14 months and 101 deaths of 19 months.The relapse-free survival rate and overall survival rate of nutritionally normal patients were higher than that of malnutrition patients (P<0.05).Multiariable Cox risk proportion model analysis results showed that liver cirrhosis (YES), tumor diameter (>5cm), TNM staging(Ⅲ+Ⅳ), TBIL (>34.67 μmol) and NRS-2002 (malnutrition) are independent risk factors for recurrence of HCC patients (P<0.05);Cirrhosis of the liver (YES), tumor diameter (>5cm), TNM staging(Ⅲ+Ⅳ)are the independent risk factors of death in patients with HCC (P<0.05).The results of internal validation showed that the 6 month, 12 month and 24 month recurrence free survival rates were 0.716(95%CI: 0.671-0.866), 0.710(95%CI: 0.624-0.838) and 0.699 (95%CI: 0.611-0.796), respectively. Conclusion: In this study, the Nomogram model was effective in predicting the recurrence free survival rate of HCC patients at 6, 12, and 24 months after surgery, which could be used to improve the perioperative treatment plan .
