title: Nomogram for preoperative estimation of long-term survival of patients who underwent curative resection with hepatocellular carcinoma beyond Barcelona clinic liver cancer stage A1.
abstract: OBJECTIVE
  This retrospective cohort study developed a prognostic nomogram to predict the survival of hepatocellular carcinoma (HCC) patients diagnosed as beyond Barcelona clinic liver cancer stage A1 after resection and evaluated the possibility of using the nomogram as a treatment algorithm reference.
  
  
  RESULTS
  The predictors included in the nomogram were total tumour volume, Child-Turcotte-Pugh class, plasma fibrinogen and portal vein tumour thrombus. Patients diagnosed as beyond A1 were stratified into low-, medium- and high-risk groups using nomogram scores of 0 and 51 with the total points of 225. Patients within A1 exhibited similar recurrence-free survival (RFS) and overall survival (OS) rates compared with the low-risk group. Patients in the medium-risk group exhibited a similar OS but a worse RFS rates compared with patients within A1. The high-risk group was associated with worse RFS and OS rates compared with the patients within A1 (3-year RFS rates, 27.0% vs. 60.3%, P < 0.001; 3-year OS rates, 49.2% vs. 83.1%, P < 0.001).
  
  
  METHODS
  A total of 352 HCC patients undergoing curative resection from September 2003 to December 2012 were included to develop a nomogram to predict overall survival after resection. Univariate and multivariate survival analysis were used to identify prognostic factors. A visually orientated nomogram was constructed using a Cox proportional hazards model.
  
  
  CONCLUSIONS
  This user-friendly nomogram offers an individualized preoperative recurrence risk estimation and stratification for HCC patients beyond A1 undergoing resection. Resection should be considered the first-line treatment for low-risk patients.
authors.affiliation: Department of Medical Oncology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangdong, China.
authors.forename: Dan-Yun
authors.initials: DY
authors.lastname: Ruan
authors.affiliation: Department of Medical Oncology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangdong, China.
authors.forename: Ze-Xiao
authors.initials: ZX
authors.lastname: Lin
authors.affiliation: Department of Medical Oncology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangdong, China.
authors.forename: Tian-Tian
authors.initials: TT
authors.lastname: Wang
authors.affiliation: Department of Liver Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Zhao
authors.affiliation: Department of Medical Oncology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangdong, China.
authors.forename: Dong-Hao
authors.initials: DH
authors.lastname: Wu
authors.affiliation: Department of Medical Oncology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangdong, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Medical Oncology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangdong, China.
authors.forename: Min
authors.initials: M
authors.lastname: Dong
authors.affiliation: Department of Medical Oncology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangdong, China.
authors.forename: Qu
authors.initials: Q
authors.lastname: Lin
authors.affiliation: Department of Medical Oncology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangdong, China.
authors.forename: Xiang-Yuan
authors.initials: XY
authors.lastname: Wu
authors.affiliation: Department of Liver Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Li
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D009367:Neoplasm Staging; D049451:Nomograms; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate
keywords: Barcelona clinic liver cancer stage; hepatocellular carcinoma; nomogram; resection; survival