Published online Nov 15, 2023. doi: 10.4251/wjgo.v15.i11.1874
Peer-review started: June 24, 2023
First decision: August 8, 2023
Revised: August 20, 2023
Accepted: September 6, 2023
Article in press: September 6, 2023
Published online: November 15, 2023
Distant metastatic hepatocellular carcinoma (HCC) patients have poor survival rates, while some of them who have survived for several months may have a better prognosis than the prediction at initial diagnosis. Conditional survival (CS) could provide patients with survival probabilities at a specific time since the prognosis would be adjusted for the time the patient had already survived.
In this study, we evaluated actual survival and CS of distant metastatic HCC patients.
This study aimed to evaluate the CS of distant metastatic HCC patients and construct nomograms to predict CS at different times.
We used Cox regression analysis to identify risk factors for overall survival (OS) and the competing risk model to identify risk factors for cancer-specific survival (CSS). Six-month CS was used to calculate the probability of survival for an additional 6 mo at a specific time after the initial diagnosis. We used standardized differences to evaluate the survival differences between subgroups. Nomograms were constructed to predict CS.
Using univariate and multivariate analysis, we found positive α-fetoprotein expression, higher T stage (T3 and T4), N1 stage, non-primary site surgery, non-chemotherapy, non-radiotherapy, and lung metastasis to be independent risk factors for actual OS and CSS. We found that actual survival rates decreased over time, while CS rates gradually increased. The influence of chemotherapy and radiotherapy on survival gradually disappeared over time; the influence of age and gender on survival gradually appeared; and the influence of lung metastasis reversed. The area under the curve (AUC) of nomograms for conditional OS decreased as time passed, and the AUC for conditional CSS gradually increased.
Actual survival rates decreased over time, while CS rates gradually increased. With dynamic risk factors, nomograms constructed at different time would provide more accurate CS.
CS could be used to evaluate the dynamic survival rates for distant metastatic HCC patients.