title: Nomograms for Pre- and Postoperative Prediction of Long-term Survival for Patients Who Underwent Hepatectomy for Multiple Hepatocellular Carcinomas.
abstract: OBJECTIVE
  To develop prognostic nomograms for patients undergoing hepatectomy for multiple hepatocellular carcinomas (mHCCs).
  
  
  BACKGROUND
  The prognostic prediction after hepatectomy for mHCCs has not been well established.
  
  
  METHODS
  A training cohort (n = 540) was analyzed to construct 2 nomograms based separately on data obtained before and after hepatectomy for mHCCs at the Eastern Hepatobiliary Surgery Hospital between 2000 and 2006. The internal and external validations were performed in 2 independent cohorts (n = 180 each) collected from the Eastern Hepatobiliary Surgery Hospital between 2007 and 2010 and the Sun Yat-Sen University between 2000 and 2007. The predictive accuracy was measured by concordance index (C-index) and calibration curve.
  
  
  RESULTS
  Serum α-fetoprotein level, hepatitis B virus deoxyribonucleic acid load, end-stage liver disease score, tumor number, total tumor diameter, and the ratio of largest to smallest tumor diameter were incorporated into the preoperative nomogram for overall survival (OS) prediction. In addition to these variables, microvascular invasion, tumor capsule, type of hepatectomy, and local invasion/metastasis were incorporated into the postoperative nomogram. All calibration curves for probability of OS fitted well. In the training cohort, the preoperative nomogram achieved a C-index of 0.75 (95% confidence interval, 0.72-0.78) in predicting OS and accurately stratified patients into 4 prognostic subgroups (5-year OS rates: 65.9%, 46.3%, 29.6%, and 4.1%, P < 0.001). The postoperative nomogram had a C-index of 0.80, which was higher than those of the 4 conventional staging systems (0.53-0.62). These results were supported by the internal and external validations.
  
  
  CONCLUSIONS
  The 2 nomograms showed accurate pre- and postoperative prediction of posthepatectomy prognosis in patients with mHCCs.
authors.affiliation: *Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China †Department of Hepatobiliary Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, China ‡State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University, Guangzhou, China §Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
authors.forename: Pinghua
authors.initials: P
authors.lastname: Yang
authors.forename: Jiliang
authors.initials: J
authors.lastname: Qiu
authors.forename: Jun
authors.initials: J
authors.lastname: Li
authors.forename: Dong
authors.initials: D
authors.lastname: Wu
authors.forename: Xuying
authors.initials: X
authors.lastname: Wan
authors.forename: Wan Yee
authors.initials: WY
authors.lastname: Lau
authors.forename: Yunfei
authors.initials: Y
authors.lastname: Yuan
authors.forename: Feng
authors.initials: F
authors.lastname: Shen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D003661:Decision Support Techniques; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D049451:Nomograms; D018579:Patient Selection; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome