Nomogram based on albumin-bilirubin grade to predict outcome of the patients with hepatitis C virus-related hepatocellular carcinoma after microwave ablation

Objective: To construct a nomogram based on the albumin-bilirubin(ALBI) grade to provide prognostic value for hepatitis C virus(HCV)-related hepatocellular carcinoma(HCC) patients who underwent ultrasound-guided percutaneous microwave ablation(US-PMWA).Methods: From April 2005 to January 2018, 183 treatment-na?ve patients with 251 HCV-related HCCs according to the Milan criteria received US-PMWA subsequently. The overall survival(OS) and recurrence-free survival(RFS) were compared between groups classified by ALBI grade. Cox proportional hazard regression model based on risk factors for survival and recurrence was used to construct the nomogram.Results: The cumulative OS rates at 1-, 3-, 5-and 10-year were 97.7%, 73.6%, 54.5% and 34.5%, respectively. Stratified according to ALBI grade, the 1-, 3-, and 5-year OS in the ALBI grade 1 group and grade 2 group were 99.2%, 92.4%, 77.9% and 97.7%,52.3%, 38.6%, respectively, with significant statistical difference(P < 0.001). No significant statistical difference was detected in the1-, 3-, and 5-year RFS rates in the ALBI grade 1 group and grade 2 group(P = 0.220). The major complication rate was 1.6%.Multivariate analysis results showed age, α-fetoprotein level, tumor number, platelet count, location, Child-Turcotte-Pugh(CTP)and ALBI grade were associated with OS, which generated the nomograms. Internal validation with 1000 bootstrapped sample sets had good concordance index of 0.769(95%CI 0.699-0.839) in OS.Conclusions: This nomogram based on ALBI grade was a visualization risk model, which could provide personalized prediction of long-term outcomes for HCV-related HCC patients after US-PMWA.