Nomogram based on albumin-bilirubin grade to predict outcome of the patients with hepatitis C virus-related hepatocellular carcinoma after microwave ablation

Objective: To construct a nomogram based on the albumin-bilirubin (ALBI) grade to provide prognostic value for hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC) patients who underwent ultrasound-guided percutaneous microwave ablation (US-PMWA). Methods: From April 2005 to January 2018, 183 treatment-naive patients with 251 HCV-related HCCs according to the Milan criteria received US-PMWA subsequently. The overall survival (OS) and recurrence-free survival (RFS) were compared between groups classified by ALBI grade. Cox proportional hazard regression model based on risk factors for survival and recurrence was used to construct the nomogram. Results: The cumulative OS rates at 1-, 3-, 5- and 10-year were 97.7%, 73.6%, 54.5% and 34.5%, respectively. Stratified according to ALBI grade, the 1-, 3-, and 5-year OS in the ALBI grade 1 group and grade 2 group were 99.2%, 92.4%, 77.9% and 97.7%, 52.3%, 38.6%, respectively, with significant statistical difference (P < 0.001). No significant statistical difference was detected in the 1-, 3-, and 5-year RFS rates in the ALBI grade 1 group and grade 2 group (P = 0.220). The major complication rate was 1.6%. Multivariate analysis results showed age, a-fetoprotein level, tumor number, platelet count, location, Child-Turcotte-Pugh (CTP) and ALBI grade were associated with OS, which generated the nomograms. Internal validation with 1000 bootstrapped sample sets had good concordance index of 0.769 (95%CI 0.699-0.839) in OS. Conclusions: This nomogram based on ALBI grade was a visualization risk model, which could provide personalized prediction of long-term outcomes for HCV-related HCC patients after US-PMWA.