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| Surgical resection versus liver transplantation for hepatocellular carcinoma within the Hangzhou criteria: a preoperative nomogram-guided treatment strategy |
| Yang Li, Dan-Yun Ruan, Chang-Chang Jia, Hui Zhao, Guo-Ying Wang, Yang Yang and Nan Jiang |
Guangzhou, China
Author Affiliations: Department of Hepatic Surgery and Liver Transplantation Center of the Third Affiliated Hospital, Organ Transplantation Institute of Sun Yat-Sen University, Organ Transplantation Research Center of Guangdong Province, Guangzhou 510630, China (Li Y, Zhao H, Wang GY, Yang Y and Jiang N); Department of Medical Oncology (Ruan DY) and Department of Biotherapy (Jia CC), the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
Corresponding Author: Nan Jiang, MD, PhD, Department of Hepatic Surgery and Liver Transplantation Center of the Third Affiliated Hospital, Organ Transplantation Institute of Sun Yat-Sen University, Organ Transplantation Research Center of Guangdong Province, Guangzhou 510630, China (Tel: +86-20-85252177; Fax: +86-20-85252276; Email: njiang163@163.com) |
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Abstract BACKGROUND: With the expansion of surgical criteria, the comparative efficacy between surgical resection (SR) and liver transplantation (LT) for hepatocellular carcinoma is inconclusive. This study aimed to develop a prognostic nomogram for predicting recurrence-free survival of hepatocellular carcinoma patients after resection and explored the possibility of using nomogram as treatment algorithm reference.
METHODS: From 2003 to 2012, 310 hepatocellular carcinoma patients within Hangzhou criteria undergoing resection or liver transplantation were included. Total tumor volume, albumin level, HBV DNA copies and portal hypertension were included for constructing the nomogram. The resection patients were stratified into low- and high-risk groups by the median nomogram score of 116. Independent risk factors were identified and a visually orientated nomogram was constructed using a Cox proportional hazards model to predict the recurrence risk for SR patients.
RESULTS: The low-risk SR group had better outcomes compared with the high-risk SR group (3-year recurrence-free survival rate, 71.1% vs 35.9%; 3-year overall survival rate, 89.8% vs 78.9%, both P<0.001). The high-risk SR group was associated with a worse recurrence-free survival rate but similar overall survival rate compared with the transplantation group (3-year recurrence-free survival rate, 35.9% vs 74.1%, P<0.001; 3-year overall survival rate, 78.9% vs 79.6%, P>0.05).
CONCLUSIONS: This nomogram offers individualized recurrence risk evaluation for hepatocellular carcinoma patients within Hangzhou criteria receiving resection. Transplantation should be considered the first-line treatment for high-risk patients.
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2017, Vol. 16 
