The Singapore Liver Cancer Recurrence (SLICER) Score for relapse prediction in patients with surgically resected hepatocellular carcinoma

Surgery is the primary curative option in patients with hepatocellular carcinoma (HCC). Current prognostic models for HCC are developed on datasets of primarily patients with advanced cancer, and may be less relevant to resectable HCC. We developed a postoperative nomogram, the Singapore Liver Cance...

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Bibliographic Details
Published in:PloS one 2015-04, Vol.10 (4), p.e0118658-e0118658
Main Authors: Ang, Soo Fan, Ng, Elizabeth Shu-Hui, Li, Huihua, Ong, Yu-Han, Choo, Su Pin, Ngeow, Joanne, Toh, Han Chong, Lim, Kiat Hon, Yap, Hao Yun, Tan, Chee Kiat, Ooi, London Lucien Peng Jin, Cheow, Peng Chung, Chung, Alexander Yaw Fui, Chow, Pierce Kah Hoe, Foo, Kian Fong, Tan, Min-Han
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Bioindicators
Biomarkers
Cancer
Cancer patients
Cancer recurrence
Carcinoma, Hepatocellular - diagnosis
Carcinoma, Hepatocellular - epidemiology
Carcinoma, Hepatocellular - surgery
Care and treatment
Cirrhosis
Clinical trials
Cluster Analysis
Clustering
Data reduction
Decision analysis
Female
Gastroenterology
Gene expression
Glycoproteins
Health services
Hepatitis
Hepatocellular carcinoma
Hepatology
Hospitals
Humans
Likelihood ratio
Liver
Liver cancer
Liver cirrhosis
Liver Neoplasms - diagnosis
Liver Neoplasms - epidemiology
Liver Neoplasms - surgery
Liver transplants
Male
Mathematical models
Medical imaging
Medical prognosis
Metastasis
Middle Aged
Models, Statistical
NMR
Nomograms
Nuclear magnetic resonance
Oncology
Pathology
Patients
Predictions
Probability
Prognosis
Recurrence
Singapore - epidemiology
Statistical analysis
Surgery
Surgical instruments
Surveillance
Transformation
Transplants & implants
α-Fetoprotein
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Description
Summary:Surgery is the primary curative option in patients with hepatocellular carcinoma (HCC). Current prognostic models for HCC are developed on datasets of primarily patients with advanced cancer, and may be less relevant to resectable HCC. We developed a postoperative nomogram, the Singapore Liver Cancer Recurrence (SLICER) Score, to predict outcomes of HCC patients who have undergone surgical resection. Records for 544 consecutive patients undergoing first-line curative surgery for HCC in one institution from 1992-2007 were reviewed, with 405 local patients selected for analysis. Freedom from relapse (FFR) was the primary outcome measure. An outcome-blinded modeling strategy including clustering, data reduction and transformation was used. We compared the performance of SLICER in estimating FFR with other HCC prognostic models using concordance-indices and likelihood analysis. A nomogram predicting FFR was developed, incorporating non-neoplastic liver cirrhosis, multifocality, preoperative alpha-fetoprotein level, Child-Pugh score, vascular invasion, tumor size, surgical margin and symptoms at presentation. Our nomogram outperformed other HCC prognostic models in predicting FFR by means of log-likelihood ratio statistics with good calibration demonstrated at 3 and 5 years post-resection and a concordance index of 0.69. Using decision curve analysis, SLICER also demonstrated superior net benefit at higher threshold probabilities. The SLICER score enables well-calibrated individualized predictions of relapse following curative HCC resection, and may represent a novel tool for biomarker research and individual counseling.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0118658