title: The Singapore Liver Cancer Recurrence (SLICER) Score for relapse prediction in patients with surgically resected hepatocellular carcinoma.
abstract: OBJECTIVE
  Surgery is the primary curative option in patients with hepatocellular carcinoma (HCC). Current prognostic models for HCC are developed on datasets of primarily patients with advanced cancer, and may be less relevant to resectable HCC. We developed a postoperative nomogram, the Singapore Liver Cancer Recurrence (SLICER) Score, to predict outcomes of HCC patients who have undergone surgical resection.
  
  
  METHODS
  Records for 544 consecutive patients undergoing first-line curative surgery for HCC in one institution from 1992-2007 were reviewed, with 405 local patients selected for analysis. Freedom from relapse (FFR) was the primary outcome measure. An outcome-blinded modeling strategy including clustering, data reduction and transformation was used. We compared the performance of SLICER in estimating FFR with other HCC prognostic models using concordance-indices and likelihood analysis.
  
  
  RESULTS
  A nomogram predicting FFR was developed, incorporating non-neoplastic liver cirrhosis, multifocality, preoperative alpha-fetoprotein level, Child-Pugh score, vascular invasion, tumor size, surgical margin and symptoms at presentation. Our nomogram outperformed other HCC prognostic models in predicting FFR by means of log-likelihood ratio statistics with good calibration demonstrated at 3 and 5 years post-resection and a concordance index of 0.69. Using decision curve analysis, SLICER also demonstrated superior net benefit at higher threshold probabilities.
  
  
  CONCLUSIONS
  The SLICER score enables well-calibrated individualized predictions of relapse following curative HCC resection, and may represent a novel tool for biomarker research and individual counseling.
authors.affiliation: Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Republic of Singapore.
authors.forename: Soo Fan
authors.initials: SF
authors.lastname: Ang
authors.affiliation: Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Republic of Singapore.
authors.forename: Elizabeth Shu-Hui
authors.initials: ES
authors.lastname: Ng
authors.affiliation: Health Services Research, Singapore General Hospital, Singapore, Republic of Singapore; Centre for Quantitative Medicine, Duke-National University of Singapore Graduate Medical School, Singapore, Republic of Singapore.
authors.forename: Huihua
authors.initials: H
authors.lastname: Li
authors.affiliation: Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Republic of Singapore.
authors.forename: Yu-Han
authors.initials: YH
authors.lastname: Ong
authors.affiliation: Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Republic of Singapore.
authors.forename: Su Pin
authors.initials: SP
authors.lastname: Choo
authors.affiliation: Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Republic of Singapore.
authors.forename: Joanne
authors.initials: J
authors.lastname: Ngeow
authors.affiliation: Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Republic of Singapore.
authors.forename: Han Chong
authors.initials: HC
authors.lastname: Toh
authors.affiliation: Department of Pathology, Singapore General Hospital, Singapore, Republic of Singapore.
authors.forename: Kiat Hon
authors.initials: KH
authors.lastname: Lim
authors.affiliation: Department of General Surgery, Singapore General Hospital, Singapore, Republic of Singapore.
authors.forename: Hao Yun
authors.initials: HY
authors.lastname: Yap
authors.affiliation: Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, Republic of Singapore.
authors.forename: Chee Kiat
authors.initials: CK
authors.lastname: Tan
authors.affiliation: Department of Hepatobiliary and Transplant Surgery, Singapore General Hospital, Singapore, Republic of Singapore.
authors.forename: London Lucien Peng Jin
authors.initials: LL
authors.lastname: Ooi
authors.forename: Peng Chung
authors.initials: PC
authors.lastname: Cheow
authors.affiliation: Department of Hepatobiliary and Transplant Surgery, Singapore General Hospital, Singapore, Republic of Singapore.
authors.forename: Alexander Yaw Fui
authors.initials: AY
authors.lastname: Chung
authors.affiliation: Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Republic of Singapore; Office of Clinical Sciences, Duke-National University of Singapore Graduate Medical School, Singapore, Republic of Singapore.
authors.forename: Pierce Kah Hoe
authors.initials: PK
authors.lastname: Chow
authors.affiliation: Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Republic of Singapore.
authors.forename: Kian Fong
authors.initials: KF
authors.lastname: Foo
authors.affiliation: Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Republic of Singapore.
authors.forename: Min-Han
authors.initials: MH
authors.lastname: Tan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D016000:Cluster Analysis; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011336:Probability; D011379:Prognosis; D012008:Recurrence; D012846:Singapore / Q000453:epidemiology
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