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A nomogram to predict survival of patients with intermediate-stage hepatocellular carcinoma after transarterial chemoembolization combined with microwave ablation

  • Interventional
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European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To develop a prognostic nomogram based on the albumin–bilirubin (ALBI) grade for prediction of the long-term survival of patients with intermediate-stage hepatocellular carcinoma (HCC) after transarterial chemoembolization combined with microwave ablation (TACE-MWA).

Methods

We retrospectively studied 546 consecutive patients with intermediate-stage HCC according to the Barcelona Clinic Liver Cancer guidelines who underwent TACE-MWA between January 2000 and December 2016. Overall survival (OS) and progression-free survival (PFS) were analyzed. The predictive value of the ALBI grade was investigated. The prognostic nomogram was constructed using the independent predictors assessed by the multivariate Cox proportional hazards model.

Results

After a median follow-up of 35.0 months (range, 4.0–221.0 months), 380 patients had died. The median OS was 35.0 months (95% confidence interval (CI), 30.84–39.16 months), and the median PFS was 6.5 months (95% CI, 6.13–6.87 months). The ALBI grade was validated as an independent predictor of OS (p < 0.001). Multivariate analyses showed that Eastern Cooperative Oncology Group performance status score more than 0, presence of liver cirrhosis, a-fetoprotein level above 400 ng/mL, tumor size greater than 5 cm, tumor number more than 3, advanced ALBI grade, and treatment sessions of TACE or MWA fewer than 3 were independently associated with overall mortality. The prognostic nomogram incorporating these eight predictors achieved good calibration and discriminatory abilities with a concordance index of 0.770 (95% CI, 0.746–0.795).

Conclusions

The prognostic nomogram based on the ALBI grade resulted in reliable efficacy for prediction of individualized OS in patients with intermediate-stage HCC after TACE-MWA.

Key Points

• TACE-MWA was associated with a median overall survival of 35.0 months for patients with intermediate-stage HCC.

• A prognostic nomogram was built to predict individualized survival of patients with intermediate-stage HCC after TACE-MWA.

• The prognostic nomogram incorporating eight predictors achieved good calibration and discriminatory abilities with a concordance index of 0.770.

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Abbreviations

AFP:

a-Fetoprotein level

ALBI:

Albumin–bilirubin

CI:

Confidence interval

cm:

Centimeter

CP:

Child–Pugh

CT:

Computed tomography

ECOG:

Eastern Cooperative Oncology Group

HBV:

Hepatitis B virus

HCC:

Hepatocellular carcinoma

HCV:

Hepatitis C virus

HR:

Hazard ratio

INR:

International normalized ratio

MRI:

Magnetic resonance imaging

MWA:

Microwave ablation

OS:

Overall survival

PFS:

Progression-free survival

TACE:

Transarterial chemoembolization

References

  1. Forner A, Llovet JM, Bruix J (2012) Hepatocellular carcinoma. Lancet 379(9822):1245–1255

    Article  Google Scholar 

  2. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D (2011) Global cancer statistics. CA Cancer J Clin 61(2):69–90

    Article  Google Scholar 

  3. Cui W, Fan W, Huang K et al (2018) Large hepatocellular carcinomas: treatment with transarterial chemoembolization alone or in combination with percutaneous cryoablation. Int J Hyperthermia 35(1):239–245

    Article  Google Scholar 

  4. Tsurusaki M, Murakami T (2015) Surgical and locoregional therapy of HCC: TACE. Liver Cancer 4(3):165–175

    Article  CAS  Google Scholar 

  5. Hyun MH, Lee YS, Kim JH et al (2018) Hepatic resection compared to chemoembolization in intermediate- to advanced-stage hepatocellular carcinoma: a meta-analysis of high-quality studies. Hepatology 68(3):977–993

    Article  CAS  Google Scholar 

  6. Zhang R, Shen L, Zhao L, Guan Z, Chen Q, Li W (2018) Combined transarterial chemoembolization and microwave ablation versus transarterial chemoembolization in BCLC stage B hepatocellular carcinoma. Diagn Interv Radiol 24(4):219–224

    PubMed  PubMed Central  Google Scholar 

  7. Chen QF, Jia ZY, Yang ZQ, Fan WL, Shi HB (2017) Transarterial chemoembolization monotherapy versus combined transarterial chemoembolization-microwave ablation therapy for hepatocellular carcinoma tumors ≤5 cm: a propensity analysis at a single center. Cardiovasc Intervent Radiol 40(11):1748–1755

    Article  Google Scholar 

  8. Veltri A, Gazzera C, Calandri M et al (2015) Percutaneous treatment of hepatocellular carcinoma exceeding 3 cm: combined therapy or microwave ablation? Preliminary results. Radiol Med 120(12):1177–1183

    Article  Google Scholar 

  9. Iezzi R, Pompili M, Posa A et al (2019) Interventional oncology treatments for unresectable early stage HCC in patients with a high risk for intraprocedural bleeding: is a single-step combined therapy safe and feasible? Eur J Radiol 114:32–37

    Article  Google Scholar 

  10. Li W, Ni CF (2019) Current status of the combination therapy of transarterial chemoembolization and local ablation for hepatocellular carcinoma. Abdom Radiol (NY) 44(6):2268–2275

    Article  Google Scholar 

  11. Dufour JF, Bargellini I, De Maria N, De Simone P, Goulis I, Marinho RT (2013) Intermediate hepatocellular carcinoma: current treatments and future perspectives. Ann Oncol 24(Suppl 2):ii24–ii29

    Article  Google Scholar 

  12. Mohammadi H, Abuodeh Y, Jin W et al (2018) Using the albumin-bilirubin (ALBI) grade as a prognostic marker for radioembolization of hepatocellular carcinoma. J Gastrointest Oncol 9(5):840–846

    Article  Google Scholar 

  13. Hiraoka A, Kumada T, Kudo M et al (2017) Albumin-bilirubin (ALBI) grade as part of the evidence-based clinical practice guideline for HCC of the Japan Society of Hepatology: a comparison with the liver damage and Child-Pugh classifications. Liver Cancer 6(3):204–215

    Article  Google Scholar 

  14. Durand F, Valla D (2008) Assessment of prognosis of cirrhosis. Semin Liver Dis 28(1):110–122

    Article  CAS  Google Scholar 

  15. Procopet B, Tantau M, Bureau C (2013) Are there any alternative methods to hepatic venous pressure gradient in portal hypertension assessment? J Gastrointestin Liver Dis 22(1):73–78

    PubMed  Google Scholar 

  16. Johnson PJ, Berhane S, Kagebayashi C et al (2015) Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach-the ALBI grade. J Clin Oncol 33(6):550–558

    Article  Google Scholar 

  17. Pinato DJ, Sharma R, Allara E et al (2017) The ALBI grade provides objective hepatic reserve estimation across each BCLC stage of hepatocellular carcinoma. J Hepatol 66(2):338–346

    Article  Google Scholar 

  18. Hansmann J, Evers MJ, Bui JT et al (2017) Albumin-bilirubin and platelet-albumin-bilirubin grades accurately predict overall survival in high-risk patients undergoing conventional transarterial chemoembolization for hepatocellular carcinoma. J Vasc Interv Radiol 28(9):1224–1231

    Article  Google Scholar 

  19. Jaruvongvanich V, Sempokuya T, Wong L (2018) Is there an optimal staging system or liver reserve model that can predict outcome in hepatocellular carcinoma? J Gastrointest Oncol 9(4):750–761

    Article  Google Scholar 

  20. Balachandran VP, Gonen M, Smith JJ, DeMatteo RP (2015) Nomograms in oncology: more than meets the eye. Lancet Oncol 16(4):e173–e180

    Article  Google Scholar 

  21. Tian G, Yang S, Yuan J et al (2018) Comparative efficacy of treatment strategies for hepatocellular carcinoma: systematic review and network meta-analysis. BMJ Open 8(10):e021269

    Article  Google Scholar 

  22. Hu H, Chen GF, Yuan W, Wang JH, Zhai B (2018) Microwave ablation with chemoembolization for large hepatocellular carcinoma in patients with cirrhosis. Int J Hyperthermia 34(8):1351–1358

  23. Ni JY, Sun HL, Chen YT et al (2014) Prognostic factors for survival after transarterial chemoembolization combined with microwave ablation for hepatocellular carcinoma. World J Gastroenterol 20(46):17483–17490

    Article  Google Scholar 

  24. Kao WY, Chiou YY, Hung HH et al (2012) Younger hepatocellular carcinoma patients have better prognosis after percutaneous radiofrequency ablation therapy. J Clin Gastroenterol 46(1):62–70

    Article  Google Scholar 

  25. Choi JW, Chung JW, Lee DH et al (2018) Portal hypertension is associated with poor outcome of transarterial chemoembolization in patients with hepatocellular carcinoma. Eur Radiol 28(5):2184–2193

    Article  Google Scholar 

  26. He Y, Ong Y, Li X et al (2019) Performance of prediction models on survival outcomes of colorectal cancer with surgical resection: a systematic review and meta-analysis. Surg Oncol 29:196–202

    Article  Google Scholar 

  27. Guo BL, Ouyang FS, Ouyang LZ et al (2019) Development and validation of an ultrasound-based nomogram to improve the diagnostic accuracy for malignant thyroid nodules. Eur Radiol 29(3):1518–1526

    Article  Google Scholar 

  28. Hong JY, You JS, Kim MJ et al (2019) Development and external validation of new nomograms by adding ECG changes (ST depression or tall T wave) and age to conventional scoring systems to improve the predictive capacity in patients with subarachnoid haemorrhage: a retrospective, observational study in Korea. BMJ Open 9(2):e024007

    Article  Google Scholar 

  29. Ye FG, Xia C, Ma D, Lin PY, Hu X, Shao ZM (2018) Nomogram for predicting preoperative lymph node involvement in patients with invasive micropapillary carcinoma of breast: a SEER population-based study. BMC Cancer 18(1):1085

    Article  Google Scholar 

  30. Okamura Y, Hinata N, Terakawa T et al (2019) External validation of nomograms for prediction of progression-free survival and liver toxicity in patients with advanced renal cell carcinoma treated with pazopanib. Int J Clin Oncol 24(6):698–705

    Article  CAS  Google Scholar 

  31. Tattersall HL, Callegaro D, Ford SJ, Gronchi A (2018) Staging, nomograms and other predictive tools in retroperitoneal soft tissue sarcoma. Chin Clin Oncol 7(4):36

    Article  Google Scholar 

  32. Kao WY, Su CW, Chiou YY et al (2017) Hepatocellular carcinoma: nomograms based on the albumin-bilirubin grade to assess the outcomes of radiofrequency ablation. Radiology 285(2):670–680

    Article  Google Scholar 

  33. Zhong BY, Ni CF, Ji JS et al (2019) Nomogram and artificial neural network for prognostic performance on the albumin-bilirubin grade for hepatocellular carcinoma undergoing transarterial chemoembolization. J Vasc Interv Radiol 30(3):330–338

    Article  Google Scholar 

Download references

Funding

This study was funded by the National Natural Science Foundation of China (grant number 81771955, 81901854); the Guangzhou Science and Technology Program (Key Projects of Collaborative Innovation of Health Medicine) (grant number 201704020228); the Guangzhou Science and Technology Program (Key Projects of Collaborative Innovation of Production, Learning and Research) (grant number 201704020134); the Sun Yat-sen University Clinical Trial 5010 Project (grant number 2016002); the Scientific Research Foundation of Medical Science of Guangdong Province, China (grant number A2018267) from Guangdong Science and Technology Department (2017B030314026); and was also supported by Grant [2013]163 from Key Laboratory of Malignant Tumor Molecular Mechanism and Translational Medicine of Guangzhou Bureau of Science and Information Technology, and Grant KLB09001 from the Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes.

Author information

Author notes

  1. Jia-yan Ni and Zhu-ting Fang contributed equally to this work.

Authors and Affiliations

  1. Department of Minimally Invasive Interventional Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Cancer for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong Province, People’s Republic of China

    Jia-yan Ni, Chao An, Zhi-mei Huang, Tian-qi Zhang & Jin-hua Huang

  2. Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang Road West, Guangzhou, 510120, Guangdong Province, People’s Republic of China

    Jia-yan Ni, Hong-liang Sun, Xiong-ying Jiang, Yao-ting Chen & Lin-feng Xu

  3. Department of Interventional Radiology, Fujian Provincial Hospital, Provincial Clinic College of Fujian Medical University, Fuzhou, People’s Republic of China

    Zhu-ting Fang

  4. Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, People’s Republic of China

    Chao An

Authors
  1. Jia-yan Ni
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  2. Zhu-ting Fang
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  10. Jin-hua Huang
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Corresponding authors

Correspondence to Lin-feng Xu or Jin-hua Huang.

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Guarantor

The scientific guarantor of this publication is Jin-hua Huang.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all patients in this study.

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Institutional Review Board approval was obtained.

Methodology

• retrospective

• prognostic study

• multicenter study

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Ni, Jy., Fang, Zt., Sun, Hl. et al. A nomogram to predict survival of patients with intermediate-stage hepatocellular carcinoma after transarterial chemoembolization combined with microwave ablation. Eur Radiol 30, 2377–2390 (2020). https://doi.org/10.1007/s00330-019-06438-8

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