Modified preoperative score to predict disease-free survival for hepatocellular carcinoma patients with surgical resections

Table 1 Clinicopathological characteristics and univariate analysis of 1106 patients

	n (%)	P value
Preoperative variables
Age (yr)		0.202
≤ 55	436 (39)
> 55	670 (61)
Sex		0.098
Male	863 (78)
Female	243 (22)
Viral hepatitis		0.111
No viral hepatitis	185 (17)
Hepatitis B or C or B + C	921 (83)
Child Class		0.964
A/B	1099 (99)
C	7 (1)
Platelet count (103/μL)		0.003
< 100	124 (11)
≥ 100	982 (89)
Total bilirubin (mg/dL)		0.032
≤ 1.3	1010 (91)
> 1.3	96 (9)
PT-INR		0.053
≤ 1.2	1004 (91)
> 1.2	102 (9)
Albumin (g/dL)		0.001
< 3.5	86 (8)
≥ 3.5	1020 (92)
AFP (ng/mL)		0.116
< 200	785 (71)
≥ 200	321 (29)
ICG (%)		< 0.0001
≤ 10	748 (68)
> 10	358 (32)
Multiplicity		< 0.0001
Solitary	852 (77)
Multiple	254 (23)
Radiologic TTV (cm3)		< 0.0001
mean ± SD	113.06 ± 237.13
≤ 32.0	645 (58)
> 32.0	461 (42)
Postoperative variables
Resection margin (cm)		0.082
≤ 1.0	817 (74)
> 1.0	249 (23)
Liver cirrhosis		0.001
No	585 (53)
Yes	521 (47)
Tumor rupture		0.004
No	1076 (97)
Yes	30 (3)
Edmondson-Steiner grade		< 0.0001
I/II	682 (62)
III/IV	424 (38)
Capsule		0.789
No	192 (17)
Yes	914 (83)
Microvascular invasion		< 0.0001
No	786 (71)
Yes	320 (29)
Pathologic TTV (cm3)		< 0.0001
mean ± SD	131.59 ± 293.81
≤ 32.8	652 (59)
> 32.8	454 (41)

PT-INR: International normalized ratio of prothrombin time; AFP: Alpha fetoprotein; ICG: Indocyanine green; TTV: Total tumor volume; SD: Standard deviation.

Table 2 Univariate and multivariate analysis of prognostic factors

	UV P value	HR	95%CI	MV P value
Platelet count (103/μL)	0.003		1.192-1.882	0.001
< 100		1.498
≥ 100		1
Total bilirubin (mg/dL)	0.032			-
≤ 1.3
> 1.3
Albumin (g/dL)	0.001		1.121-1.907	0.005
< 3.5		1.462
≥ 3.5		1
ICG (%)	< 0.0001		1.104-1.507	0.001
≤ 10		1
> 10		1.289
Multiplicity	< 0.0001		1.422-2.019	< 0.0001
Solitary		1
Multiple		1.694
Radiologic TTV (cm3)	< 0.0001		1.501-2.024	< 0.0001
≤ 32.0		1
> 32.0		1.743

UV: Univariate; HR: Hazard ratio; CI: Confidence interval; MV: Multivariate; ICG: Indocyanine green; TTV: Total tumor volume.

Table 3 Point values for risk groups according to the Cox regression model

Predictor variables	Regression coefficients (β)	Categories	Reference value (W)	Β (W-WREF)	Points = β (W-WREF)/constant B
Platelet count (103/μL)	0.4039	< 100000	1	0.4039	2
		≥ 100000	0 (WREF)	0	0
Albumin (g/dL)	0.3805	< 3.5	1	0.3805	1
		≥ 3.5	0 (WREF)	0	0
ICG (%)	0.2544	≤ 10	0 (WREF)	0	0
		> 10	1	0.25441	1
Multiplicity	0.5274	Solitary	0 (WREF)	0	0
		Multiple	1	0.5274	2
Radiologic TTV (cm3)	0.5558	≤ 32.0	0 (WREF)	0	0
		> 32.0	1	0.5558	2

¹Base constant (constant B).

ICG: Indocyanine green; TTV: Total tumor volume.

Table 4 Discrimination measures and hazard ratios evaluated among four scoring systems

Scoring system	CGMH				AJCC 8th edition				Tokyo				Taipei
	Estimate		SE		Estimate		SE		Estimate		SE		Estimate		SE
Measures of discrimination
Harrell’s CH	0.617		0.01		0.617		0.01		0.613		0.011		0.562		0.01
Gonen and Heller’s CGH	0.599		0.009		0.586		0.009		0.587		0.01		539		0.009
Royston & Sauerbrei’s D	0.672		0.066		0.577		0.065		0.589		0.066		0.292		0.067
Prognostic scoring system	HR	95%CI of HR		P value	HR	95%CI of HR		P value	HR	95%CI of HR		P value	HR	95%CI of HR		P value
CGMH: Low1	1				1				1				1
Intermediate, high	1.81	1.50-2.19		< 0.0001	1.35	1.08-1.69		0.009	1.55	1.04-2.29		0.03	1.21	1.01-1.45		0.039
AJCC 8th edition:	2.74	2.25-3.34		< 0.0001	1.69	1.29-2.21		< 0.001	1.7	1.16-2.49		0.007	1.43	1.08-1.88		0.012
IA1, IB, II, IIIA, IIIB					2.08	1.57-2.76		< 0.0001	2.64	1.76-3.96		< 0.0001	1.79	1.31-2.44		< 0.001
Tokyo: 01, 1, 2, 3, 4, 5					3.15	2.41-4.12		< 0.0001	4.14	2.70-6.36		< 0.0001	1.26	0.97-1.64		0.079
Taipei: 01, 1, 2, 3, 4									4.1	2.54-6.63		< 0.0001

¹Reference category.

The CGMH risk groups were categorized according to the ascending possibility of the 16^th, 50^th, and 84^th percentiles.

CI: Confidence interval; HR: Hazard ratio; SE: Standard error.

Table 5 Performance of prognostic scoring systems

Prognostic scoring system	Homogeneity	Discriminatory ability	Akaike information criterion
	Likelihood ratio χ2	Linear trend χ2
CGMH	106.05	106.48	9305.48
AJCC 8th	81.53	94.16	9336.01
Tokyo	93.02	109.45	9324.52
Taipei	18.76	20.41	9396.77