A novel nomogram predicting the early recurrence of hepatocellular carcinoma patients after R0 resection

Huanhuan Wang; Runkun Liu; Huanye Mo; Runtian Li; Jie Lian; Qingguang Liu; Shaoshan Han

doi:10.3389/fonc.2023.1133807

A novel nomogram predicting the early recurrence of hepatocellular carcinoma patients after R0 resection

Front Oncol. 2023 Mar 17:13:1133807. doi: 10.3389/fonc.2023.1133807. eCollection 2023.

Authors

Huanhuan Wang¹, Runkun Liu¹, Huanye Mo¹, Runtian Li¹, Jie Lian², Qingguang Liu¹, Shaoshan Han¹

Affiliations

¹ Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
² Department of Pathology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.

Abstract

Background: Early tumor recurrence is one of the most significant poor prognostic factors for patients with HCC after R0 resection. The aim of this study is to identify risk factors of early recurrence, in addition, to develop a nomogram model predicting early recurrence of HCC patients.

Methods: A total of 481 HCC patients after R0 resection were enrolled and divided into a training cohort (n = 337) and a validation cohort (n = 144). Risk factors for early recurrence were determined based on Cox regression analysis in the training cohort. A nomogram incorporating independent risk predictors was established and validated.

Results: Early recurrence occurred in 37.8% of the 481 patients who underwent curative liver resection of HCC. AFP ≥ 400 ng/mL (HR: 1.662; P = 0.008), VEGF-A among 127.8 to 240.3 pg/mL (HR: 1.781, P = 0.012), VEGF-A > 240.3 pg/mL (HR: 2.552, P < 0.001), M1 subgroup of MVI (HR: 2.221, P = 0.002), M2 subgroup of MVI (HR: 3.120, P < 0.001), intratumor necrosis (HR: 1.666, P = 0.011), surgical margin among 5.0 to 10.0 mm (HR: 1.601, P = 0.043) and surgical margin < 5.0 mm (HR: 1.790, P = 0.012) were found to be independent risk factors for recurrence-free survival in the training cohort and were used for constructing the nomogram. The nomogram indicated good predictive performance with an AUC of 0.781 (95% CI: 0.729-0.832) and 0.808 (95% CI: 0.731-0.886) in the training and validation cohorts, respectively.

Conclusions: Elevated serum concentrations of AFP and VEGF-A, microvascular invasion, intratumor necrosis, surgical margin were independent risk factors of early intrahepatic recurrence. A reliable nomogram model which incorporated blood biomarkers and pathological variables was established and validated. The nomogram achieved desirable effectiveness in predicting early recurrence in HCC patients.

Keywords: MVI; VEGF-A; early recurrence; hepatocellular carcinoma; nomogram model.

Grants and funding

This study was supported by a grant from the National Natural Science Foundation of China (No. 81602566 and 81874069), the Natural Science Foundation of Shaanxi Province (No. 2022JM-535), the Fundamental Research Funds for the Central Universities (No. xzy012020050) and the "Basic-Clinical" Fusion Innovation Project of Xi'an Jiaotong University (YXJLRH2022020).