Article Abstract

Preoperative survival calculator for resectable hepatocellular carcinoma

Authors: Emmanuel Gabriel, Jin Kim, Katherine T. Ostapoff, Kristopher Attwood, Sergei Kurenov, Boris Kuvshinoff, Steven N. Hochwald, Steven J. Nurkin


Background: Estimation of preoperative overall survival (OS) of hepatocellular carcinoma (HCC) may guide surgical decision-making.
Methods: OS was analyzed using the National Cancer Data Base from 1998–2012. Patients with HCC who underwent wedge resection, lobectomy or extended lobectomy were selected. Patients who had metastatic disease or previous treatment prior to surgery were excluded. Data was randomly allocated to model building (nb =4,364) and validation cohorts (nv =1,091). Multivariable regression analyses of the nb were used to construct prediction models and optimized using nv.
Results: HCC patients (n=5,455) who underwent curative resection had a median OS of 36 months (95% CI, 34–38 months) with 1- and 3-year OS of 73% (95% CI, 72–74%) and 50% (95% CI, 49–51%), respectively. The patient median age was 65, 66% of patients were male, median tumor size was 60 mm; clinical stage 1 =25%, stage 2 =30% and stage 3 =45%. Alpha fetoprotein (AFP) was elevated in 63% of patients. Factors significant in the prediction model included degree of resection, age, race, tumor size, grade, and histologic subtype.
Conclusions: A preoperative OS calculator was developed to assist in the treatment evaluation and OS prediction of HCC patients.