Published online Aug 26, 2021. doi: 10.12998/wjcc.v9.i24.7009
Peer-review started: March 13, 2021
First decision: June 3, 2021
Revised: June 12, 2021
Accepted: July 5, 2021
Article in press: July 5, 2021
Published online: August 26, 2021
Processing time: 163 Days and 12.6 Hours
Surgery is the main treatment for hepatocellular carcinoma (HCC). However, 30%-50% of patients develop recurrence within 2 years, which is the main cause of death.
Screening patients with high recurrence risk plays an important role in making reasonable clinical decisions.
To combine contrast-enhanced ultrasound (CEUS) liver imaging reporting and data system (LIRADS) with serology biomarkers to construct a non-invasive model predicting the early recurrence of HCC, and verify the model.
Records of 744 consecutive patients undergoing first-line curative surgery for HCC in one institution from 2016–2018 were reviewed, and 292 local patients were selected for analysis. General characteristics, CEUS liver imaging reporting and data system (LIRADS) parameters, and serology biomarkers were collected. Univariate analysis and multivariate analyses were performed to evaluate the independent prognostic factors for tumor recurrence. Then, a nomogram called CEUS model was constructed. The CEUS model was then used to predict recurrence at 6 mo, 12 mo, and 24 mo.
Tumor diameter, preoperative alpha-fetoprotein (AFP) level, and LIRADS were identified to be independent hazard factors, with a hazard ratio of 1.123 (95% confidence interval [CI]: 1.041-1.211), 1.547 (95%CI: 1.245-1.922), and 1.428 (95%CI: 1.059-1.925), separately. A nomogram based on them was constructed; the cut-off value at 6 mo, 12 mo, and 24 mo was 100, 80, and 50, and the C-index was 0.748 (95%CI: 0.683-0.813), 0.762 (95%CI: 0.704-0.820), and 0.762 (95%CI: 0.706-0.819), separately. The calibration at 6 mo was desirable; however, the calibration at 12 and 24 mo should be improved.
The CEUS model can screen out patients who have a high recurrence risk, it is helpful for making reasonable treatment strategy.
A multi-center study, with an expanded sample size and prospective verification, is required.