Abstract
PURPOSE: Accurate estimation of survival is of utmost importance in patients with hepatocellular carcinoma (HCC) and extrahepatic metastasis. This study aimed to develop a survival prediction model using real-world data. PATIENTS AND METHODS: A total of 993 patients with treatment-naïve HCC and extrahepatic metastasis were included from 13 Korean hospitals between 2013 and 2018. Patients were randomly divided into a training set (70.0%) and a test set (30.0%). The eXtreme Gradient Boosting (XGBoost) algorithm was applied to predict survival at 3, 6, and 12 months. RESULTS: The mean age of the patients was 60.8 ± 12.3 years, and 85.4% were male. During the study period, 96.1% died, and median survival duration was 4.0 months. In multivariate analysis, Child-Pugh class, number and size of tumors, presence of vascular or bile duct invasion, lung or bone metastasis, serum AFP, and primary anti-HCC treatment were associated with survival. We constructed a model for survival prediction based on the relevant variables, which is available online (https://metastatic-hcc.onrender.com/form). Our model demonstrated high performance, with areas under the receiver operating characteristic curves of 0.778, 0.794, and 0.784 at 3, 6, and 12 months, respectively. Feature importance analysis indicated that the primary anti-HCC treatment had the highest importance. CONCLUSION: We developed a model to predict the survival of patients with HCC and extrahepatic metastasis, which demonstrated good discriminative ability. Our model would be helpful for personalized treatment and for improving the prognosis.