OBJECTIVES To develop a prognostic nomogram based on the albumin-bilirubin (ALBI) grade for prediction of the long-term survival of patients with intermediate-stage hepatocellular carcinoma (HCC) after transarterial chemoembolization combined with microwave ablation (TACE-MWA). METHODS We retrospectively studied 546 consecutive patients with intermediate-stage HCC according to the Barcelona Clinic Liver Cancer guidelines who underwent TACE-MWA between January 2000 and December 2016. Overall survival (OS) and progression-free survival (PFS) were analyzed. The predictive value of the ALBI grade was investigated. The prognostic nomogram was constructed using the independent predictors assessed by the multivariate Cox proportional hazards model. RESULTS After a median follow-up of 35.0 months (range, 4.0-221.0 months), 380 patients had died. The median OS was 35.0 months (95% confidence interval (CI), 30.84-39.16 months), and the median PFS was 6.5 months (95% CI, 6.13-6.87 months). The ALBI grade was validated as an independent predictor of OS (p < 0.001). Multivariate analyses showed that Eastern Cooperative Oncology Group performance status score more than 0, presence of liver cirrhosis, a-fetoprotein level above 400 ng/mL, tumor size greater than 5 cm, tumor number more than 3, advanced ALBI grade, and treatment sessions of TACE or MWA fewer than 3 were independently associated with overall mortality. The prognostic nomogram incorporating these eight predictors achieved good calibration and discriminatory abilities with a concordance index of 0.770 (95% CI, 0.746-0.795). CONCLUSIONS The prognostic nomogram based on the ALBI grade resulted in reliable efficacy for prediction of individualized OS in patients with intermediate-stage HCC after TACE-MWA. KEY POINTS • TACE-MWA was associated with a median overall survival of 35.0 months for patients with intermediate-stage HCC. • A prognostic nomogram was built to predict individualized survival of patients with intermediate-stage HCC after TACE-MWA. • The prognostic nomogram incorporating eight predictors achieved good calibration and discriminatory abilities with a concordance index of 0.770.

中文翻译：

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预测经动脉化疗栓塞联合微波消融后中期肝细胞癌患者生存的列线图。

目的 开发基于白蛋白胆红素 (ALBI) 等级的预后列线图，用于预测经动脉化疗栓塞联合微波消融 (TACE-MWA) 后中期肝细胞癌 (HCC) 患者的长期生存率。方法 我们根据巴塞罗那临床肝癌指南，回顾性研究了 546 例在 2000 年 1 月至 2016 年 12 月期间接受 TACE-MWA 的连续中期 HCC 患者。分析了总生存期 (OS) 和无进展生存期 (PFS)。研究了 ALBI 等级的预测价值。使用由多变量 Cox 比例风险模型评估的独立预测因子构建预后列线图。结果 在中位随访 35.0 个月（范围，4.0-221.0 个月）后，380 名患者死亡。中位 OS 为 35.0 个月（95% 置信区间 (CI)，30.84-39.16 个月），中位 PFS 为 6.5 个月（95% CI，6.13-6.87 个月）。ALBI 等级被验证为 OS 的独立预测因子 (p < 0.001)。多变量分析显示 Eastern Cooperative Oncology Group 体能状态评分大于 0、存在肝硬化、甲胎蛋白水平高于 400 ng/mL、肿瘤大小大于 5 cm、肿瘤数量大于 3、晚期 ALBI 分级和治疗疗程少于 3 的 TACE 或 MWA 与总死亡率独立相关。包含这八个预测因子的预后列线图实现了良好的校准和辨别能力，一致性指数为 0.770（95% CI，0.746-0.795）。结论 基于 ALBI 分级的预后列线图对预测 TACE-MWA 后中期 HCC 患者的个体化 OS 具有可靠的疗效。要点 • TACE-MWA 与中期 HCC 患者的中位总生存期 35.0 个月相关。• 建立了预后列线图来预测TACE-MWA 后中期HCC 患者的个体化生存。• 包含八个预测因子的预后列线图实现了良好的校准和辨别能力，一致性指数为0.770。• 建立了预后列线图来预测TACE-MWA 后中期HCC 患者的个体化生存。• 包含八个预测因子的预后列线图实现了良好的校准和辨别能力，一致性指数为0.770。• 建立了预后列线图来预测TACE-MWA 后中期HCC 患者的个体化生存。• 包含八个预测因子的预后列线图实现了良好的校准和辨别能力，一致性指数为0.770。