A Nomogram-Based Prognostic Model for Advanced Hepatocellular Carcinoma Patients Treated with Sorafenib: A Multicenter Study
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. ITA.LI.CA Database
2.2. Design
2.3. Statistical Analysis
3. Results
3.1. Baseline Characteristics
3.2. Predictive Factors of Overall Survival
- ECOG PS (HR, 1.284; 95% CI, 1.123–1.460; p < 0.001);
- MTD (HR, 1.100; 95% CI, 1.069–1.133; p < 0.001);
- Bilirubin (HR, 1.119; 95% CI, 1.004–1.246; p = 0.042);
- Multiple of AST UNL (HR, 1.032; 95% CI, 1.001–1.065; p = 0.041);
- AFP ≥ 200 ng/mL (HR, 1.342; 95% CI, 1.113–1.618; p = 0.002);
- Hemoglobin (HR, 0.903; 95% CI, 0.860–0.948; p < 0.001);
- Platelet count (HR, 1.002; 95% CI, 1.001–1.003; p < 0.001).
3.3. Predictive Factors of Tumor Response
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristic | Number of Patients | Number (%) or Mean (SD) |
---|---|---|
Age at diagnosis of HCC (years) | 1107 | 64.3 (13.0) |
Sex (M) | 1107 | 904 (81.7) |
BMI | 1107 | 25.07 (4.24) |
Karnofsky score | 1107 | 83.0 (13.7) |
ECOG PS | 1107 | - |
0 | - | 627 (56.7) |
1 | - | 373 (33.7) |
2 | - | 91 (8.2) |
3 | - | 16 (1.4) |
Liver disease etiology | 1097 | - |
HCV | - | 455 (41.5) |
HBV | - | 111 (10.1) |
Alcohol | - | 126 (11.5) |
Metabolic | - | 68 (6.2) |
Other causes/multiple etiology | - | 297 (27.1) |
MELD score | 1031 | 10 (3.22) |
Child–Pugh class | 1009 | - |
A | - | 662 (65.6) |
B | - | 330 (32.7) |
C | - | 17 (1.7) |
Esophageal varices | 1107 | 436 (39.4) |
HCC Features | ||
BCLC | 1049 | - |
0-A | - | 111 (10.2) |
B | - | 205 (18.9) |
C | - | 706 (65.1) |
D | - | 27 (2.5) |
ITA.LI.CA. Prognostic Score | 1107 | - |
1 | - | 54 (4.9) |
2 | - | 113 (10.2) |
3 | - | 566 (51.1) |
4 | - | 374 (33.8) |
Number of nodules | 992 | 3 (2.4) |
HCC Grading | 312 | - |
1–2 | - | 163 (52.2) |
3–4 | - | 149 (47.8) |
Maximum tumor diameter (cm) | 1107 | 4.70 (3.14) |
Vascular invasion/thrombosis | 1107 | 425 (38.4) |
Absent | - | 682 (61.6) |
Portal vein | - | 258 (23.3) |
Peripheral | - | 167 (15.1) |
Metastases | 1107 | 427 (38.6) |
Extent >50% liver volume | 996 | 131 (13.1) |
Maximum tumor diameter (cm) | 1107 | 4.70 (3.14) |
Death | 1107 | 882 (79.7) |
Survival after initiation of Sorafenib (months) (median (IQR)) * | 1107 | 10.1 (4.1; 20.2) |
Time of Sorafenib administration (months) (median (IQR)) * | 1085 | 4.1 (2.0; 12.2) |
Response to Sorafenib (mRECIST) | 780 | - |
Progression | - | 517 (66.2) |
Stable | - | 166 (21.3) |
Partial regression | - | 77 (9.9) |
Complete regression | - | 20 (2.6) |
Laboratory Tests | ||
Albumin (g/dL) | 1056 | 3.54 (0.55) |
Total bilirubin (mg/dL) | 1056 | 1.33 (1.37) |
INR | 1021 | 1.19 (0.25) |
ALT (multiple of UNL) | 1107 | 1.63 (1.80) |
AST (multiple of UNL) | 1107 | 1.96 (2.42) |
GGT (multiple of UNL) | 1107 | 3.54 (3.72) |
ALP (multiple of UNL) | 1106 | 3.43 (3.77) |
Alpha-fetoprotein (ng/mL) | 1087 | 2404 (5955) |
Creatinine (mg/dL) | 1022 | 0.92 (0.45) |
Na+ (mmol/L) | 855 | 138.73 (4.2) |
K+ (mmol/L) | 851 | 4.30 (0.5) |
Hemoglobin (g/dL) | 962 | 12.70 (1.9) |
Platelets (×109/L) | 979 | 144.9 (86.9) |
Variable | Univariate | Multivariate | |||
---|---|---|---|---|---|
HR (95% CI) | p | HR (95% CI) | p | ||
ECOG PS | 1.287 (1.172; 1.414) | <0.001 | 1.284 (1.123; 1.460) | <0.001 | |
MELD score | 1.035 (1.017; 1.054) | <0.001 | - | - | |
Child–Pugh class | 1.357 (1.185; 1.556) | <0.001 | - | - | |
BCLC stage | 1.238 (1.132; 1.354) | <0.001 | - | - | |
Esophageal varices | 1.087 (1.010; 1.171) | 0.026 | - | - | |
Maximum tumor diameter (cm) * | 1.077 (1.052; 1.102) | <0.001 | 1.100 (1.069; 1.133) | <0.001 | |
Vascular invasion/thrombosis | |||||
Absent | Reference | - | - | - | |
Portal vein | 1.303 (1.109; 1.532) | 0.001 | - | - | |
Peripheral | 1.360 (1.125; 1.645) | 0.001 | - | - | |
HCC extension >50% liver volume | 1.792 (1.460; 2.199) | <0.001 | - | - | |
Albumin (g/dL) * | 0.806 (0.710; 0.916) | 0.001 | - | - | |
Total bilirubin (mg/dL) * | 1.082 (1.039; 1.127) | <0.001 | 1.119 (1.004; 1.246) | 0.042 | |
INR* | 1.320 (1.032; 1.689) | 0.027 | - | - | |
AST (multiple of UNL) * | 1.029 (1.002; 1.057) | 0.035 | 1.032 (1.001; 1.065) | 0.041 | |
ALP (multiple of UNL) * | 1.020 (1.003: 1.037) | 0.023 | - | - | |
Alpha-fetoprotein (≥200 ng/mL) | 1.285 (1.136; 1.455) | <0.001 | 1.342 (1.113; 1.618) | 0.002 | |
Serum sodium (mmol/L) * | 0.973 (0.955; 0.993) | 0.007 | - | - | |
Hemoglobin (g/dL) * | 0.918 (0.885; 0.952) | <0.001 | 0.903 (0.860; 0.948) | <0.001 | |
Platelets (×109/L) * | 1.002 (1.001; 1.002) | <0.001 | 1.002 (1.001; 1.003) | <0.001 |
Variable | Univariate | Multivariate | ||
---|---|---|---|---|
OR (95% CI) | p | OR (95% CI) | p | |
ECOG PS | 1.270 (1.020; 1.581) | 0.033 | - | - |
Maximum tumor diameter (cm) * | 1.083 (1.025; 1.145) | 0.005 | 1.068 (1.006; 1.134) | 0.031 |
Albumin (g/dL) * | 0.753 (0.570; 0.996) | 0.047 | - | - |
Platelets (×109/L) * | 1.003 (1.001; 1.005) | 0.001 | 1.003 (1.001; 1.005) | 0.023 |
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Marasco, G.; Poggioli, F.; Colecchia, A.; Cabibbo, G.; Pelizzaro, F.; Giannini, E.G.; Marinelli, S.; Rapaccini, G.L.; Caturelli, E.; Di Marco, M.; et al. A Nomogram-Based Prognostic Model for Advanced Hepatocellular Carcinoma Patients Treated with Sorafenib: A Multicenter Study. Cancers 2021, 13, 2677. https://doi.org/10.3390/cancers13112677
Marasco G, Poggioli F, Colecchia A, Cabibbo G, Pelizzaro F, Giannini EG, Marinelli S, Rapaccini GL, Caturelli E, Di Marco M, et al. A Nomogram-Based Prognostic Model for Advanced Hepatocellular Carcinoma Patients Treated with Sorafenib: A Multicenter Study. Cancers. 2021; 13(11):2677. https://doi.org/10.3390/cancers13112677
Chicago/Turabian StyleMarasco, Giovanni, Francesco Poggioli, Antonio Colecchia, Giuseppe Cabibbo, Filippo Pelizzaro, Edoardo Giovanni Giannini, Sara Marinelli, Gian Ludovico Rapaccini, Eugenio Caturelli, Mariella Di Marco, and et al. 2021. "A Nomogram-Based Prognostic Model for Advanced Hepatocellular Carcinoma Patients Treated with Sorafenib: A Multicenter Study" Cancers 13, no. 11: 2677. https://doi.org/10.3390/cancers13112677