Asian Pacific Journal of Cancer Prevention

Asian Pacific Journal of Cancer Prevention (아시아태평양암예방학회)
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Prognostic Evaluation of Categorical Platelet-based Indices Using Clustering Methods Based on the Monte Carlo Comparison for Hepatocellular Carcinoma

  • Guo, Pi (Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University) ;
  • Shen, Shun-Li (Department of Hepatobiliary Surgery, the First Affiliated Hospital, Sun Yat-sen University) ;
  • Zhang, Qin (Good Clinical Practice Office, Cancer Hospital of Shantou University Medical College) ;
  • Zeng, Fang-Fang (Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University) ;
  • Zhang, Wang-Jian (Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University) ;
  • Hu, Xiao-Min (Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University) ;
  • Zhang, Ding-Mei (Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University) ;
  • Peng, Bao-Gang (Department of Hepatobiliary Surgery, the First Affiliated Hospital, Sun Yat-sen University) ;
  • Hao, Yuan-Tao (Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University)
  • Published : 2014.07.30
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Abstract

Objectives: To evaluate the performance of clustering methods used in the prognostic assessment of categorical clinical data for hepatocellular carcinoma (HCC) patients in China, and establish a predictable prognostic nomogram for clinical decisions. Materials and Methods: A total of 332 newly diagnosed HCC patients treated with hepatic resection during 2006-2009 were enrolled. Patients were regularly followed up at outpatient clinics. Clustering methods including the Average linkage, k-modes, fuzzy k-modes, PAM, CLARA, protocluster, and ROCK were compared by Monte Carlo simulation, and the optimal method was applied to investigate the clustering pattern of the indices including platelet count, platelet/lymphocyte ratio (PLR) and serum aspartate aminotransferase activity/platelet count ratio index (APRI). Then the clustering variable, age group, tumor size, number of tumor and vascular invasion were studied in a multivariable Cox regression model. A prognostic nomogram was constructed for clinical decisions. Results: The ROCK was best in both the overlapping and non-overlapping cases performed to assess the prognostic value of platelet-based indices. Patients with categorical platelet-based indices significantly split across two clusters, and those with high values, had a high risk of HCC recurrence (hazard ratio [HR] 1.42, 95% CI 1.09-1.86; p<0.01). Tumor size, number of tumor and blood vessel invasion were also associated with high risk of HCC recurrence (all p< 0.01). The nomogram well predicted HCC patient survival at 3 and 5 years. Conclusions: A cluster of platelet-based indices combined with other clinical covariates could be used for prognosis evaluation in HCC.

Keywords

References

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