A practical nomogram predicting the prognosis of hepatocellular carcinoma patients with lymph node metastasis: A population-based analysis
Abstract Background: Lymph node (LN) metastasis is associated with poor survival outcomes in patients with hepatocellular carcinoma (HCC) patients and because of the reported low probability of lymph node metastasis, research into the Anchorprognoses of such patients is difficult to conduct. In this study, we aimed to develop a nomogram model to predict the prognosis of HCC patients with lymph node metastasis. Methods: HCC patients diagnosed with LN metastasis from 2010 to 2015 were enrolled from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate Cox regression and lasso regression were used to screen prognostic factors. Cox multiple-factor analysis was used to investigate the independent risk factors for survival. We developed a prognostic nomograms using these independent risk factors. The predictive performance of our nomogram model was evaluated according to the concordance index (C-index) and calibration curve. The net clinical benefit was assessed via decision curve analysis (DCA). Patients were divided into different risk groups according to the model. A survival curve was drawn using the Kaplan-Meier method and the difference was compared by the log-rank test. Results: There were 944 patients in the training cohort and 402 patients in the validation cohort. Grade, T stage, surgery to the liver, chemotherapy, radiation recode, AFP, fibrosis score, tumor size group, M stage were selected as independent prognostic factors, and we developed nomograms using these variables. The calibration curves for probability of survival showed good agreement between the prediction by our model and actual observation in both the training and validation groups. DCA indicated that the nomogram had positive net benefits. Conclusions: The nomogram can accurately predict the prognosis of HCC patients with lymph nodes metastasis and provide a reasonable basis for treatment. Keywords: Hepatocellular carcinoma, prognosis, lymph nodes metastasis, prediction model, nomogram