An internally validated new clinical and inflammation-based prognostic score for patients with advanced hepatocellular carcinoma treated with sorafenib View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2017-08-11

AUTHORS

R. Diaz-Beveridge, G. Bruixola, D. Lorente, J. Caballero, E. Rodrigo, Á. Segura, D. Akhoundova, A. Giménez, J. Aparicio

ABSTRACT

BackgroundSorafenib is a standard treatment for patients (pts) with advanced hepatocellular carcinoma (aHCC), although the clinical benefit is heterogeneous between different pts groups. Among novel prognostic factors, a low baseline neutrophil-to-lymphocyte ratio (bNLR) and early-onset diarrhoea have been linked with a better prognosis.PurposeTo identify prognostic factors in pts with aHCC treated with 1st-line sorafenib and to develop a new prognostic score to guide management.Materials and methodsRetrospective review of 145 pts bNLR, overall toxicity, early toxicity rates and overall survival (OS) were assessed. Univariate and multivariate analysis of prognostic factors for OS was performed. The prognostic score was calculated from the coefficients found in the Cox analysis. ROC curves and pseudoR2 index were used for internal validation. Discrimination ability and calibration were tested by Harrel’s c-index (HCI) and Akaike criteria (AIC).ResultsThe optimal bNLR cut-off for the prediction of OS was 4 (AUC 0.62). Independent prognostic factors in multivariate analysis for OS were performance status (PS) (p < .0001), Child–Pugh (C–P) score (p = 0.005), early-onset diarrhoea (p = 0.006) and BNLR (0.011). The prognostic score based on these four variables was found efficient (HCI = 0.659; AIC = 1.180). Four risk groups for OS could be identified: a very low-risk (median OS = 48.6 months), a low-risk (median OS = 11.6 months), an intermediate-risk (median OS = 8.3 months) and a high-risk group (median OS = 4.4 months).ConclusionsPS and C–P score were the main prognostic factors for OS, followed by early-onset diarrhoea and bNLR. We identified four risk groups for OS depending on these parameters. This prognostic model could be useful for patient stratification, but an external validation is needed. More... »

PAGES

322-329

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s12094-017-1720-4

DOI

http://dx.doi.org/10.1007/s12094-017-1720-4

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1091158222

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/28801777


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38 schema:description BackgroundSorafenib is a standard treatment for patients (pts) with advanced hepatocellular carcinoma (aHCC), although the clinical benefit is heterogeneous between different pts groups. Among novel prognostic factors, a low baseline neutrophil-to-lymphocyte ratio (bNLR) and early-onset diarrhoea have been linked with a better prognosis.PurposeTo identify prognostic factors in pts with aHCC treated with 1st-line sorafenib and to develop a new prognostic score to guide management.Materials and methodsRetrospective review of 145 pts bNLR, overall toxicity, early toxicity rates and overall survival (OS) were assessed. Univariate and multivariate analysis of prognostic factors for OS was performed. The prognostic score was calculated from the coefficients found in the Cox analysis. ROC curves and pseudoR2 index were used for internal validation. Discrimination ability and calibration were tested by Harrel’s c-index (HCI) and Akaike criteria (AIC).ResultsThe optimal bNLR cut-off for the prediction of OS was 4 (AUC 0.62). Independent prognostic factors in multivariate analysis for OS were performance status (PS) (p < .0001), Child–Pugh (C–P) score (p = 0.005), early-onset diarrhoea (p = 0.006) and BNLR (0.011). The prognostic score based on these four variables was found efficient (HCI = 0.659; AIC = 1.180). Four risk groups for OS could be identified: a very low-risk (median OS = 48.6 months), a low-risk (median OS = 11.6 months), an intermediate-risk (median OS = 8.3 months) and a high-risk group (median OS = 4.4 months).ConclusionsPS and C–P score were the main prognostic factors for OS, followed by early-onset diarrhoea and bNLR. We identified four risk groups for OS depending on these parameters. This prognostic model could be useful for patient stratification, but an external validation is needed.
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45 schema:keywords BackgroundSorafenib
46 Child-Pugh score
47 Cox analysis
48 Harrel's C
49 MethodsRetrospective review
50 PT group
51 Pt
52 PurposeTo
53 ROC curve
54 ResultsThe optimal bNLR
55 ability
56 advanced hepatocellular carcinoma
57 analysis
58 bNLR
59 baseline
60 benefits
61 better prognosis
62 calibration
63 carcinoma
64 clinical benefit
65 coefficient
66 criteria
67 curves
68 diarrhea
69 different pts groups
70 discrimination ability
71 early toxicity rates
72 early-onset diarrhoea
73 external validation
74 factors
75 group
76 hepatocellular carcinoma
77 high-risk group
78 independent prognostic factor
79 index
80 inflammation-based prognostic scores
81 internal validation
82 line sorafenib
83 lower baseline
84 lymphocyte ratio
85 main prognostic factors
86 management
87 materials
88 model
89 multivariate analysis
90 new prognostic score
91 novel prognostic factor
92 optimal bNLR
93 overall survival
94 overall toxicity
95 parameters
96 patient stratification
97 patients
98 performance status
99 prediction
100 prediction of OS
101 prognosis
102 prognostic factors
103 prognostic model
104 prognostic score
105 pseudoR2 index
106 pts bNLR
107 rate
108 ratio
109 review
110 risk groups
111 scores
112 sorafenib
113 standard treatment
114 status
115 stratification
116 survival
117 toxicity
118 toxicity rates
119 treatment
120 validation
121 variables
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