Prognostic nomogram for hepatocellular carcinoma with fibrosis of varying degrees

Abstract Background To investigate prognostic value of varying degrees of liver fibrosis in hepatocellular carcinoma (HCC) patients and establish an effective prognostic nomogram. Methods Eligible HCC patients with different degrees of fibrosis between 2004 and 2015 were matched from the Surveillance, Epidemiology, and End Results (SEER) database using propensity score matching (PSM). Prognostic value was evaluated using Kaplan-Meier and Cox hazard analysis. The nomogram on variables selected by multivariate analyses was established and subjected to internal validation. The predictive accuracy of nomograms was tested by concordance index (C-index) and calibration. Results HCC patients with advanced fibrosis/ cirrhosis was correlated with poor survival than those with none/moderate fibrosis in all patients [HR: 1.111, 95%CI (1.042-1.185); p=0.001] and in the PSM cohort [HR: 1.131, 95%CI (1.032-1.240); p=0.009]. Multivariate analysis of propensity-matched cohort revealed that age more than 63, higher fibrosis score, AJCC stage T3-4, distant metastasis (M1), Tumor size ≥1, vascular invasion and elevated AFP level were independent factors. The nomogram integrating these factors offers an effective prognostic prediction for HCC patients (C-index 0.749, 95%CI: 0.735~0.763) relative to AJCC 7th edition (0.727) and TNM (0.73). The calibration plots suggested optimal agreement between nomogram prediction and actual observation. Conclusions Increased fibrosis was an independent risk factor for HCC survival. The prognostic nomogram integrating fibrosis score offers a more accurate prediction.