A Novel Nomogram to Predict Prolonged Survival After Hepatectomy in Repeat Recurrent Hepatocellular Carcinoma

Background: Repeat hepatectomy is the important treatment for repeat recurrent hepatocellular carcinoma (HCC) patients. Methods: This study was a multicenter retrospective analysis of 1135 patients who underwent primary curative liver resection for HCC. One hundred recurrent patients with second hepatectomy were included to develop a nomogram to predict the risk of post-recurrence survival (PRS). Thirty eight patients in another institution were used to externally validate the nomogram. Univariate and multivariate Cox regression analyses were used to identify independent risk factors of PRS. Discrimination, calibration, and Kaplan-Meier curves were used to evaluate the model performance. Results: The nomogram was based on variables associated with PRS after HCC recurrence, including TNM stage; albumin and aspartate aminotransferase levels at recurrence; tumor size, site, differentiation of recurrences; and time to recurrence (TTR). The discriminative ability of the nomogram showed well as indicated by the C statistics (0.758 and 0.811 for training cohort and external validation cohorts, respectively), which was better than that of the TNM staging system (0.609 and 0.609, respectively). The calibration curves showed ideal agreement between the prediction and the real observations. The AUCs of the training cohort and external validation cohorts were 0.843 and 0.890, respectively. The Kaplan-Meier curve of established nomogram also performed better than those of both TNM and BCLC staging system. Conclusions: We constructed a nomogram to predict PRS in patients with repeat hepatectomy (RH) after repeat recurrence of HCC.