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Clinical Study

Using prognostic and predictive clinical features to make personalised survival prediction in advanced hepatocellular carcinoma patients undergoing sorafenib treatment

Abstract

Background

Sorafenib is the current standard of care for patients with advanced hepatocellular carcinoma (aHCC) and has been shown to improve survival by about 3 months compared to placebo. However, survival varies widely from under three months to over two years. The aim of this study was to build a statistical model that allows personalised survival prediction following sorafenib treatment.

Methods

We had access to 1130 patients undergoing sorafenib treatment for aHCC as part of the control arm for two phase III randomised clinical trials (RCTs). A multivariable model was built that predicts survival based on baseline clinical features. The statistical approach permits both group-level risk stratification and individual-level survival prediction at any given time point. The model was calibrated, and its discrimination assessed through Harrell’s c-index and Royston-Sauerbrei’s R2D.

Results

The variables influencing overall survival were vascular invasion, age, ECOG score, AFP, albumin, creatinine, AST, extra-hepatic spread and aetiology. The model-predicted survival very similar to that observed. The Harrell’s c-indices for training and validation sets were 0.72 and 0.70, respectively indicating good prediction.

Conclusions

Our model (‘PROSASH’) predicts patient survival using baseline clinical features. However, it will require further validation in a routine clinical practice setting.

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Acknowledgements

We are grateful to Professor Patrick Royston for his advice on the statistical methodology applied in this paper and to Bristol Myers Squibb and Pfizer for providing the data. This study has been previously presented at The International Liver Congress, 53rd annual meeting of the European Association for the Study of the Liver (EASL), Paris, France, 2018.

Author contributions

Concept and design: P.J., S.B. Statistical analysis: S.B., R.F., M.G.F. Drafting of the manuscript: all.

Author information

Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

The subjects in this study were part of two large trials that were previously published. As such, ethical approval has been acquired and study performed in accordance with the Declaration of Helsinki, with all patients giving informed consent.

Funding

S.B. and M.G.F. acknowledge support from the UK EPSRC grant EP/N014499/1.

Consent to publish

Not applicable

Data availability

All data remain the property of the sponsors of the trials from which they were extracted, as noted in the acknowledgments section.

Note

This work is published under the standard license to publish agreement. After 12 months the work will become freely available and the license terms will switch to a Creative Commons Attribution 4.0 International (CC BY 4.0).

Correspondence to Philip Johnson.

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