A new nomogram for prognosis of hepatocellular carcinoma
Huang et al. (1) recently established a predictive nomogram (including the American Joint Committee on Cancer stage, race, grade, surgery, chemotherapy, radiation, tumor size, bone metastasis, and alpha-fetoprotein) with an area under the curve of 0.802, suggesting high predictive accuracy. This study screened 6,166 hepatocellular carcinoma (HCC) patients from the Surveillance, Epidemiology, and End Results (SEER) database and randomly divided them into a training cohort (70%) and a validation cohort (30%). This data partitioning method makes the research results more convincing as it provides a way to validate the model performance with independent datasets.
We congratulate the authors for their creative work, one of the highlights of this study is that it provides a convenient clinical tool that can be used for personalized clinical decision-making. By using this nomogram, doctors can better evaluate the patient’s survival and develop more precise treatment plans for them. This can not only improve treatment effectiveness, but also improve the quality of life of patients.
However, there are also some limitations to this study. Firstly, due to the characteristics of the SEER database, this study may not be able to represent HCC patients from all regions. Secondly, the study did not consider some factors that may affect the prognosis of patients, such as their socio-economic status and differences in medical facilities. These factors may have an impact on the survival of patients, so they should be considered in future research. Thirdly, limitations of model validation: the article only conducted internal validation on the developed model, without using external datasets for validation. This may lead to poor generalization ability of the model on external datasets. Fourthly, there may be some subjectivity and bias in selecting prognostic factors in the article. Although the article mentions some common prognostic factors for HCC, a comprehensive evaluation and screening of all possible prognostic factors have not been conducted, which may lead to the omission of some important prognostic factors. For instance, hepatitis B and C infection status are closely related to the prognosis of HCC patients.
Furthermore, as we know, HCC is mainly treated with targeted therapy, immunotherapy, and transarterial chemoembolisation (TACE), rather than radiotherapy or chemotherapy (2,3). However, these treatment modalities are not analyzed in this paper. Therefore, we suggest including these necessary factors for analysis to make the article more comprehensiveness.
In conclusion, Huang et al.’s clinical nomogram shows potential for clinical utilization in HCC patients. The authors have done an excellent job and this study is useful. However, we think more high-quality studies are needed to confirm the findings.
Acknowledgments
Funding: None.
Footnote
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Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at https://jgo.amegroups.com/article/view/10.21037/jgo-23-978/coif). The authors have no conflicts of interest to declare.
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References
- Huang S, Zhu Z, Ruan Y, et al. Prognostic factors and survival prediction in hepatocellular carcinoma: development and validation of a novel nomogram based on the SEER database. J Gastrointest Oncol 2023;14:1817-29. [Crossref] [PubMed]
- Forner A, Reig M, Bruix J. Hepatocellular carcinoma. Lancet 2018;391:1301-14. [Crossref] [PubMed]
- Sim HW, Knox J. Hepatocellular carcinoma in the era of immunotherapy. Curr Probl Cancer 2018;42:40-8. [Crossref] [PubMed]
