Hepatocellular carcinoma: Nomograms based on the albumin-bilirubin grade to assess the outcomes of radiofrequency ablation

Wei Yu Kao, Chien Wei Su, Yi You Chiou, Nai Chi Chiu, Chien An Liu, Kuan Chieh Fang, Teh Ia Huo, Yi Hsiang Huang, Chun Chao Chang, Ming Chih Hou, Han Chieh Lin, Jaw Ching Wu

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Abstract

Purpose: To construct a nomogram with the albumin-bilirubin (ALBI) grade to assess the long-term outcomes of patients with early-stage hepatocellular carcinoma (HCC) after radiofrequency ablation (RFA). Materials and Methods: This retrospective study was approved by the institutional review board, and informed consent was waived. We studied 622 treatment-naïve patients with HCC according to the Milan criteria who subsequently underwent RFA from 2002 to 2013. Baseline characteristics were collected to identify the risk factors for determination of poor overall survival after RFA. The multivariate Cox proportional hazards model based on significant prognostic factors of overall survival was used to construct the nomogram. Results: After a median follow-up time of 35.7 months, 190 patients had died. The cumulative 5- and 10-year overall survival rates were 63.1% and 48.7%, respectively. Stratified according to ALBI grade, the cumulative 5- and 10-year survival rates were 80.0% and 67.9% for patients with grade 1, respectively, and 48.6% and 35.1% for those with grades 2-3, respectively (P < .001). Multivariate analysis results showed that patient age older than 65 years, a prothrombin time international normalized ratio greater than 1.1, a-fetoprotein level greater than 20 ng/mL, multiple tumors, and ALBI grade 2 or 3 were associated with overall mortality. A nomogram was developed on the basis of these five variables. Internal validation with 200 bootstrapped sample sets had a good concordance index of 0.770 (95% confidence interval: 0.633, 0.876). Conclusion: This simple nomogram based on the ALBI grade offers personalized long-term survival data for patients with early- stage HCC who undergo RFA.

Original languageEnglish
Pages (from-to)670-680
Number of pages11
JournalRadiology
Volume285
Issue number2
DOIs
Publication statusPublished - Nov 1 2017

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Nomograms
Bilirubin
Albumins
Hepatocellular Carcinoma
Survival
Survival Rate
Fetal Proteins
International Normalized Ratio
Research Ethics Committees
Prothrombin Time
Informed Consent
Proportional Hazards Models
Multivariate Analysis
Retrospective Studies
Confidence Intervals
Mortality
Neoplasms

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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Hepatocellular carcinoma : Nomograms based on the albumin-bilirubin grade to assess the outcomes of radiofrequency ablation. / Kao, Wei Yu; Su, Chien Wei; Chiou, Yi You; Chiu, Nai Chi; Liu, Chien An; Fang, Kuan Chieh; Huo, Teh Ia; Huang, Yi Hsiang; Chang, Chun Chao; Hou, Ming Chih; Lin, Han Chieh; Wu, Jaw Ching.

In: Radiology, Vol. 285, No. 2, 01.11.2017, p. 670-680.

Research output: Contribution to journalArticle

Kao, Wei Yu ; Su, Chien Wei ; Chiou, Yi You ; Chiu, Nai Chi ; Liu, Chien An ; Fang, Kuan Chieh ; Huo, Teh Ia ; Huang, Yi Hsiang ; Chang, Chun Chao ; Hou, Ming Chih ; Lin, Han Chieh ; Wu, Jaw Ching. / Hepatocellular carcinoma : Nomograms based on the albumin-bilirubin grade to assess the outcomes of radiofrequency ablation. In: Radiology. 2017 ; Vol. 285, No. 2. pp. 670-680.
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abstract = "Purpose: To construct a nomogram with the albumin-bilirubin (ALBI) grade to assess the long-term outcomes of patients with early-stage hepatocellular carcinoma (HCC) after radiofrequency ablation (RFA). Materials and Methods: This retrospective study was approved by the institutional review board, and informed consent was waived. We studied 622 treatment-na{\"i}ve patients with HCC according to the Milan criteria who subsequently underwent RFA from 2002 to 2013. Baseline characteristics were collected to identify the risk factors for determination of poor overall survival after RFA. The multivariate Cox proportional hazards model based on significant prognostic factors of overall survival was used to construct the nomogram. Results: After a median follow-up time of 35.7 months, 190 patients had died. The cumulative 5- and 10-year overall survival rates were 63.1{\%} and 48.7{\%}, respectively. Stratified according to ALBI grade, the cumulative 5- and 10-year survival rates were 80.0{\%} and 67.9{\%} for patients with grade 1, respectively, and 48.6{\%} and 35.1{\%} for those with grades 2-3, respectively (P < .001). Multivariate analysis results showed that patient age older than 65 years, a prothrombin time international normalized ratio greater than 1.1, a-fetoprotein level greater than 20 ng/mL, multiple tumors, and ALBI grade 2 or 3 were associated with overall mortality. A nomogram was developed on the basis of these five variables. Internal validation with 200 bootstrapped sample sets had a good concordance index of 0.770 (95{\%} confidence interval: 0.633, 0.876). Conclusion: This simple nomogram based on the ALBI grade offers personalized long-term survival data for patients with early- stage HCC who undergo RFA.",
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T2 - Nomograms based on the albumin-bilirubin grade to assess the outcomes of radiofrequency ablation

AU - Kao, Wei Yu

AU - Su, Chien Wei

AU - Chiou, Yi You

AU - Chiu, Nai Chi

AU - Liu, Chien An

AU - Fang, Kuan Chieh

AU - Huo, Teh Ia

AU - Huang, Yi Hsiang

AU - Chang, Chun Chao

AU - Hou, Ming Chih

AU - Lin, Han Chieh

AU - Wu, Jaw Ching

PY - 2017/11/1

Y1 - 2017/11/1

N2 - Purpose: To construct a nomogram with the albumin-bilirubin (ALBI) grade to assess the long-term outcomes of patients with early-stage hepatocellular carcinoma (HCC) after radiofrequency ablation (RFA). Materials and Methods: This retrospective study was approved by the institutional review board, and informed consent was waived. We studied 622 treatment-naïve patients with HCC according to the Milan criteria who subsequently underwent RFA from 2002 to 2013. Baseline characteristics were collected to identify the risk factors for determination of poor overall survival after RFA. The multivariate Cox proportional hazards model based on significant prognostic factors of overall survival was used to construct the nomogram. Results: After a median follow-up time of 35.7 months, 190 patients had died. The cumulative 5- and 10-year overall survival rates were 63.1% and 48.7%, respectively. Stratified according to ALBI grade, the cumulative 5- and 10-year survival rates were 80.0% and 67.9% for patients with grade 1, respectively, and 48.6% and 35.1% for those with grades 2-3, respectively (P < .001). Multivariate analysis results showed that patient age older than 65 years, a prothrombin time international normalized ratio greater than 1.1, a-fetoprotein level greater than 20 ng/mL, multiple tumors, and ALBI grade 2 or 3 were associated with overall mortality. A nomogram was developed on the basis of these five variables. Internal validation with 200 bootstrapped sample sets had a good concordance index of 0.770 (95% confidence interval: 0.633, 0.876). Conclusion: This simple nomogram based on the ALBI grade offers personalized long-term survival data for patients with early- stage HCC who undergo RFA.

AB - Purpose: To construct a nomogram with the albumin-bilirubin (ALBI) grade to assess the long-term outcomes of patients with early-stage hepatocellular carcinoma (HCC) after radiofrequency ablation (RFA). Materials and Methods: This retrospective study was approved by the institutional review board, and informed consent was waived. We studied 622 treatment-naïve patients with HCC according to the Milan criteria who subsequently underwent RFA from 2002 to 2013. Baseline characteristics were collected to identify the risk factors for determination of poor overall survival after RFA. The multivariate Cox proportional hazards model based on significant prognostic factors of overall survival was used to construct the nomogram. Results: After a median follow-up time of 35.7 months, 190 patients had died. The cumulative 5- and 10-year overall survival rates were 63.1% and 48.7%, respectively. Stratified according to ALBI grade, the cumulative 5- and 10-year survival rates were 80.0% and 67.9% for patients with grade 1, respectively, and 48.6% and 35.1% for those with grades 2-3, respectively (P < .001). Multivariate analysis results showed that patient age older than 65 years, a prothrombin time international normalized ratio greater than 1.1, a-fetoprotein level greater than 20 ng/mL, multiple tumors, and ALBI grade 2 or 3 were associated with overall mortality. A nomogram was developed on the basis of these five variables. Internal validation with 200 bootstrapped sample sets had a good concordance index of 0.770 (95% confidence interval: 0.633, 0.876). Conclusion: This simple nomogram based on the ALBI grade offers personalized long-term survival data for patients with early- stage HCC who undergo RFA.

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