title: Prognostic evaluation of categorical platelet-based indices using clustering methods based on the Monte Carlo comparison for hepatocellular carcinoma.
abstract: OBJECTIVE
  To evaluate the performance of clustering methods used in the prognostic assessment of categorical clinical data for hepatocellular carcinoma (HCC) patients in China, and establish a predictable prognostic nomogram for clinical decisions.
  
  
  METHODS
  A total of 332 newly diagnosed HCC patients treated with hepatic resection during 2006-2009 were enrolled. Patients were regularly followed up at outpatient clinics. Clustering methods including the Average linkage, k-modes, fuzzy k-modes, PAM, CLARA, protocluster, and ROCK were compared by Monte Carlo simulation, and the optimal method was applied to investigate the clustering pattern of the indices including platelet count, platelet/lymphocyte ratio (PLR) and serum aspartate aminotransferase activity/platelet count ratio index (APRI). Then the clustering variable, age group, tumor size, number of tumor and vascular invasion were studied in a multivariable Cox regression model. A prognostic nomogram was constructed for clinical decisions.
  
  
  RESULTS
  The ROCK was best in both the overlapping and non-overlapping cases performed to assess the prognostic value of platelet-based indices. Patients with categorical platelet-based indices significantly split across two clusters, and those with high values, had a high risk of HCC recurrence (hazard ratio [HR] 1.42, 95% CI 1.09-1.86; p<0.01). Tumor size, number of tumor and blood vessel invasion were also associated with high risk of HCC recurrence (all p<0.01). The nomogram well predicted HCC patient survival at 3 and 5 years.
  
  
  CONCLUSIONS
  A cluster of platelet-based indices combined with other clinical covariates could be used for prognosis evaluation in HCC.
authors: Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China E-mail : haoyt@mail.sysu.edu.cn.
authors: Pi
authors: P
authors: Guo
authors: Shun-Li
authors: SL
authors: Shen
authors: Qin
authors: Q
authors: Zhang
authors: Fang-Fang
authors: FF
authors: Zeng
authors: Wang-Jian
authors: WJ
authors: Zhang
authors: Xiao-Min
authors: XM
authors: Hu
authors: Ding-Mei
authors: DM
authors: Zhang
authors: Bao-Gang
authors: BG
authors: Peng
authors: Yuan-Tao
authors: YT
authors: Hao
mesh_terms: D001219:Aspartate Aminotransferases / Q000097:blood; D001792:Blood Platelets; D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000401:mortality* / Q000601:surgery; D002681:China; D016000:Cluster Analysis; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood* / Q000401:mortality* / Q000601:surgery; D018655:Lymphocyte Count; D009010:Monte Carlo Method; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D049451:Nomograms; D010976:Platelet Count; D011379:Prognosis
chemical_list: D001219:Aspartate Aminotransferases