Prognostic Nomogram for Advanced Hepatocellular Carcinoma Treated with FOLFOX 4

Abstract

<br /> <strong><span style="font-size: small;">Background: </span></strong><span style="font-family: Times New Roman,Times New Roman; font-size: small;"><span style="font-family: Times New Roman,Times New Roman; font-size: small;">The Oxaliplatin plus 5-Fluorouracil /Leucovorin (FOLFOX4) regimen have been approved by Chinese Food and Drug Administration (CFDA), and covered by health insurance for patients with advanced hepatocellular </span></span><span style="font-family: Times New Roman,Times New Roman; font-size: small;"><span style="font-family: Times New Roman,Times New Roman; font-size: small;">carcinoma (HCC) in China. However, the efficacy of FOLFOX4 for HCC patients is still under debate. In this study, we aimed to establish a nomogram to identify HCC patients who might benefit from FOLFOX4 chemotherapy base on individual profile. </span></span><strong><span style="font-size: small;">Methods: </span></strong><span style="font-family: Times New Roman,Times New Roman; font-size: small;"><span style="font-family: Times New Roman,Times New Roman; font-size: small;">A total of 184 patients from the EACH study who were treated with FOLFOX4 were included in this analysis. Backward Cox proportional hazards regression combined with clinical experience was used to select variables for construction of the nomogram. The nomogram performance was assessed in terms of discrimination and calibration. The results were validated using bootstrap resampling. </span></span><strong><span style="font-size: small;">Results: </span></strong><span style="font-family: Times New Roman,Times New Roman; font-size: small;"><span style="font-family: Times New Roman,Times New Roman; font-size: small;">Six variables were included in the prognostic models based on their clinical relevance: age, maximum tumor diameter, lymph node status, aspartate </span></span><span style="font-family: Times New Roman,Times New Roman; font-size: small;"><span style="font-family: Times New Roman,Times New Roman; font-size: small;">aminotransferase (AST), total bilirubin (TBIL) and alpha-fetoprotein (AFP). The calibration curve showed that the predicted survival probabilities closely matched the actual observations. The C-index of the model was 0.75 (95%CI: 0.71-0.80). This value was significantly superior to the one for the following staging systems: BCLC (0.67, P=0.004), CUPI (0.66, P<0.001), AJCC seventh edition (0.63, P=0.002), GRETCH (0.63, P<0.001). </span></span><strong><span style="font-size: small;">Conclusions: </span></strong><span style="font-family: Times New Roman,Times New Roman; font-size: small;"><span style="font-family: Times New Roman,Times New Roman; font-size: small;">The proposed </span></span><span style="font-family: Times New Roman,Times New Roman; font-size: small;"><span style="font-family: Times New Roman,Times New Roman; font-size: small;">nomogram showed accurate prognostic prediction for 6-month overall survival of patients treated with FOLFOX4 and </span></span><span style="font-family: Times New Roman,Times New Roman; font-size: small;"><span style="font-family: Times New Roman,Times New Roman; font-size: small;">could be useful for clinicians counseling patients and making treatment decisions. </span></span>