Use of a Novel Index, the A-Index, and Its Associated Nomogram to Predict Overall Survival Rates after Radical Resection of Primary Hepatocellular Carcinoma

• DOI: 10.2139/ssrn.3387510
• Publication Date: 2020-03-24T11:37:57Z
• Authors: Bin Bin Cai; Xiang-Qing Hou; Xiang Zhou; Ting-Ting Ye; Guan Fang; Han-Zhang Huang; Xiao-Dong Bao; Wei-Ming Wang

Background: Several international staging or scoring systems don't accurately predict overall survival (OS) after radical resection of primary hepatocellular carcinoma (PHCC). Therefore, we attempted to overcome this limitation by constructing a new index (the A-index) and its associated nomogram. Methods: We selected 672 patients who underwent curative resection of PHCC between January 2007 and February 2015 at the first affiliated hospital of the Wenzhou medical university. The subjects were randomly divided into the training and validation cohorts, in the ratio of 7:3. All relevant variables of the training cohort were screened using univariate and multivariate Cox analyses to obtain independent risk factors for drawing the nomogram. Receiver operating characteristics (ROC) curves were used to compare the prognostic effects of the nomogram, A-index, BCLC, Okuda, CLIP, TNM, and combined group of four systems plus A-index. Clinical utility was assessed by decision curve analysis (DCA). We prepared the nomogram using eight independent risk factors including the A-index. Findings: The nomogram showed the strongest predictive power for the 1-year, 3-year, and 5-year OS, with the area under the ROC curve being 0.8182, 0.7892, and 0.7669, respectively. Correction curves showed consistent performance for both groups, stratification of the Kaplan-Meier curve was significant, and DCA showed the superiority of nomograms considering clinical effects. Interpretation: The A-index and its nomogram can be used for predicting PHCC patient prognosis after hepatectomy, the predictive power of the nomogram integrating the A-index for OS was optimal. Funding Statement: The authors state: "Not applicable." Declaration of Interests: All authors declare that they have no financial and personal relationships with other people or organizations that can inappropriately influence our work. Ethics Approval Statement: The research was approved by our hospital ethics committee. Patient consent was obtained by telephone.