Value of Non-tumoral Liver Volume in the Prognosis of Large Hepatocellular Carcinoma Patients After R0 Resection

Background and Aims:Hepatectomy is an effective treatment for selected patients with large hepatocellular carcinoma(HCC).This study aimed to develop a nomogram in-corporating non-tumoral liver volume(non-TLV)and liver function markers to predict the patients’overall survival(OS)and disease-free survival(DFS).Methods:Data of 198 consecutive large HCC patients who underwent hepa-tectomy at the Zhongshan Hospital Xiamen University were collected.Another 68 patients from the Mengchao Hepatobil-iary Surgery Hospital served as an external validation cohort.The nomograms were developed based on the independent prognostic factors screened by multivariate Cox regression analyses.Concordance index(C-index),calibration curves,and time-dependent receiver operating characteristic(ROC)curves were used to measure the discrimination and predic-tive accuracy of the models.Results:High HBV DNA level,low non-TLV/ICG,vascular invasion,and a poorly differenti-ated tumor were confirmed as independent risk factors for both OS and DFS.The model established in this study pre-dicted 5-year post-operative survival and DFS in good agree-ment with the actual observation confirmed by the calibra-tion curves.The C-indexes of the nomograms in predicting OS and DFS were 0.812 and 0.823 in the training cohort,0.821 and 0.846 in the internal validation cohort,and 0.724 and 0.755 in the external validation cohort.The areas under the ROC curves(AUCs)of nomograms for predicted OS and DFS at 1,3,and 5 year were 0.85,0.86,0.83 and 0.76,0.76,0.63,respectively.Conclusions:Nomograms with non-TLV/ICG predicted the prognosis of single large HCC patients ac-curately and effectively.