title: Nomograms for Predicting Outcomes after Chemoembolization in Patients with Nonmetastatic Hepatocellular Carcinoma.
abstract: OBJECTIVE
  To construct prognostic nomograms capable of estimating individual probabilities of tumor progression and overall survival (OS) at specific time points during serial transarterial chemoembolization for hepatocellular carcinoma (HCC).
  
  
  METHODS
  The study included 1,181 consecutive patients with nonmetastatic HCC undergoing repeated transarterial chemoembolization at a single tertiary referral center. Patients were assigned to 2 cohorts according to the first transarterial chemoembolization date: derivation (2004-2006; n = 854) and validation (2007; n = 327) sets. Multivariate Cox proportional hazards models were developed based on covariates derived before transarterial chemoembolization and assessed for their association with 5-year OS and 3-year progression-free survival (PFS). The accuracy of the models was internally and externally validated.
  
  
  RESULTS
  The 5-year OS of the derivation set was 25.4%, and 3-year PFS was 20.8%. Nomograms for OS and PFS were built into the derivation set incorporating the following factors: log [tumor volume] calculated as 4/3 × 3.14 × (maximum radius of tumor in cm(3)); tumor number; tumor type (nodular or infiltrative); Child-Pugh class (A or B); (model for end-stage liver disease score/10)(-2); log [α-fetoprotein]; and portal vein invasion. The models had good discrimination and calibration abilities with C-indexes of 0.80 (5-y survival) and 0.77 (3-y progression). The results of external validation confirmed that these models performed well in terms of discrimination and goodness-of-fit (C-indexes 0.77 for 5-y survival and 0.73 for 3-y progression).
  
  
  CONCLUSIONS
  Nomograms quantifying the survival and progression outcomes in patients treated with transarterial chemoembolization are useful clinical aids in providing personalized care.
authors.affiliation: Department of Gastroenterology, Asan Liver Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Republic of Korea.
authors.forename: Yeonjung
authors.initials: Y
authors.lastname: Ha
authors.affiliation: Department of Applied Statistics, Gachon University, Seoul, Republic of Korea.
authors.forename: Seungbong
authors.initials: S
authors.lastname: Han
authors.affiliation: Department of Gastroenterology, Asan Liver Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Republic of Korea. Electronic address: s5854@medimail.co.kr.
authors.forename: Ju Hyun
authors.initials: JH
authors.lastname: Shim
authors.affiliation: Department of Radiology Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Republic of Korea.
authors.forename: Gi-Young
authors.initials: GY
authors.lastname: Ko
authors.affiliation: Department of Radiology Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Republic of Korea.
authors.forename: Hyun-Ki
authors.initials: HK
authors.lastname: Yoon
authors.affiliation: Department of Radiology Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Republic of Korea.
authors.forename: Kyu-Bo
authors.initials: KB
authors.lastname: Sung
authors.affiliation: Department of Gastroenterology, Asan Liver Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Republic of Korea.
authors.forename: Danbi
authors.initials: D
authors.lastname: Lee
authors.affiliation: Department of Gastroenterology, Asan Liver Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Republic of Korea.
authors.forename: Kang Mo
authors.initials: KM
authors.lastname: Kim
authors.affiliation: Department of Gastroenterology, Asan Liver Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Republic of Korea.
authors.forename: Young-Suk
authors.initials: YS
authors.lastname: Lim
authors.affiliation: Department of Gastroenterology, Asan Liver Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Republic of Korea.
authors.forename: Young-Hwa
authors.initials: YH
authors.lastname: Chung
authors.affiliation: Department of Gastroenterology, Asan Liver Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Republic of Korea.
authors.forename: Yung Sang
authors.initials: YS
authors.lastname: Lee
authors.affiliation: Department of Gastroenterology, Asan Liver Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Republic of Korea.
authors.forename: Han Chu
authors.initials: HC
authors.lastname: Lee
mesh_terms: D017677:Age Distribution; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000401:mortality*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D049451:Nomograms; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D015996:Survival Rate; D016896:Treatment Outcome