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

Research output: Contribution to journalArticlepeer-review


External organisations

  • University of Liverpool
  • University of Bologna


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.

Bibliographic note

Berhane, Sarah Fox, Richard Garcia-Finana, Marta Cucchetti, Alessandro Johnson, Philip eng Research Support, Non-U.S. Gov't England Br J Cancer. 2019 Jul;121(2):117-124. doi: 10.1038/s41416-019-0488-4. Epub 2019 Jun 11.


Original languageEnglish
Pages (from-to)117-124
Number of pages8
JournalBritish Journal of Cancer
Issue number2
Publication statusPublished - 11 Jun 2019


  • Adult, Aged, Antineoplastic Agents/therapeutic use, Carcinoma, Hepatocellular/drug therapy, Female, Humans, Liver Neoplasms/drug therapy, Male, Middle Aged, Prognosis, Sorafenib/adverse effects