Development and Validation a Prognostic Nomogram for Hepatocellular Carcinoma Patients Incorporating with Microvascular Invasion and Hematological Biomarkers

Background: This study aimed to develop and validate a nomogram for overall survival (OS) prediction in which combine clinical characteristics and hematological biomarkers in patients with hepatocellular carcinoma (HCC). Method: We performed a retrospective analysis of 807 HCC patients. All the clinical data of these patients were collected through electronic medical record(EMR). The independent predictive variables were identified by cox regression analysis. We tested the accuracy of the nomograms by discrimination and calibration, and then plotted decision curves to assess the benefits of nomogram-assisted decisions in a clinical context, and compared with the TNM staging systems and MVI on HCC prognosis. Findings: The primary cohort consisted of 545 patients with clinicopathologically diagnosed with HCC from 2008 to 2013, while 262 patients from 2014 to 2016 in external validation cohort. Variables included in the nomograms were TNM Stage, microvascular invasion (MVI), alpha fetoprotein (AFP), platelet to lymphocyte ratio(PLR) and prothrombin time (PT). The C-index of nomogram was 0.768, which was superior than the C-index of TNM Stage(0.660, P<0.001) and MVI(0.664, P<0.001) alone in the primary cohort. In the validation cohort, the models had a C-index of 0.845, and were also statistically higher when compared to C-index values for TNM Stage(0.687, P<0.001) and MVI(0.684, P<0.001). Calibration curves showed adequate calibration of predicted and reported OS prediction throughout the range of HCC outcomes. Decision curve analysis demonstrated that the nomogram was clinically useful than the TNM Stage and MVI alone. Moreover, patients were divided into three distinct risk groups for OS by the nomogram: low risk group, middle risk group and a high risk group, respectively. Interpretation: The nomogram presents more accurate and useful prognostic power, which could be used to predict OS for patients with HCC. Funding Statement: The authors stated: No specific funding was disclosed. Declaration of Interests: The authors have declared that they have no conflict of interest. Ethics Approval Statement: The study was approved by the ethics committees in The First Affiliated Hospital of Sun Yat-sen University (Guangdong, China).