Establishment and validation of a prognostic model for hepatocellular carcinoma after radical liver resection

Purpose: The prognostic factors related to survival of primary hepatocellular carcinoma (HCC) after radical resection were analyzed in order to establish a new prognostic model for HCC patients and to shed light on personalized treatments. Methods: 141 patients pathologically diagnosed as HCC were enrolled. The independent prognostic factors affecting overall survival were identified, and a prognostic mathematical model was established. Independent samples of 21 cases were used to validate the model's ability to predict prognosis of HCC patients. Results: The median survival time was 34 months, and the 1-, 3-, and 5-year overall survival rates were 93.2%, 80%, and 68.9%, respectively. Univariate analysis showed that alpha fetoprotein (AFP) serum level, tumor size, tumor capsule, liver cirrhosis, neutrophil-to-lymphocyte ratio (NLR), and total bilirubin (TBIL) were significantly correlated with overall survival (p<0.05). Cox multivariate analysis indicated that the independent prognostic factors were AFP serum level, liver cirrhosis, tumor size, tumor capsule, and NLR. The prognostic mathematical model was: Prognostic Index (PI)= 1.725 * liver cirrhosis + 0.783 * NLR + 1.046 * AFP + 0.595 * tumor size - 0.811 * tumor capsule. Based on the PI quartiles, 3.933 (25%), 4.716 (50%), and 5.195 (75%), the patients were divided into 4 groups: low risk (PI<3.933), moderate-risk (3.933 <= PI < 4.716), high-risk (4.761 <= PI < 5.195), and very high-risk (PI >= 5.195) group. The median survival times were 60, 34, 32, and 20 months, respectively. The 1-, 2-, 3-, and 5-year cumulative survival rates were 100%, 96%, 96%, 86%; 89%, 75%, 68%, 68%; 77%, 68%, 57%, 44%; 50%, 34%, 29%, 29%, separately. The predictions of the prognostic model demonstrated good consistency with the actual results. The total accuracy rate was 80.9%, and the Kappa consistency coefficient was 0.571 (p=0.009). Conclusions: The higher the PI, the lower the postoperative cumulative survival rate and the worse the prognosis. This model can be used as an effective method to assess the prognosis of HCC patients after resection.