Development and Validation of a Prediction Model for Hepatitis B Virus-Related Hepatocellular Carcinoma Patients Receiving Postoperative Adjuvant Transarterial Chemoembolization

Xinyue Tu; Jie Zhang; Minjun Li; Fei Lu; Ting Wang; Wenfeng Gong; Bangde Xiang

doi:10.2147/JHC.S422565

Development and Validation of a Prediction Model for Hepatitis B Virus-Related Hepatocellular Carcinoma Patients Receiving Postoperative Adjuvant Transarterial Chemoembolization

J Hepatocell Carcinoma. 2023 Oct 24:10:1881-1895. doi: 10.2147/JHC.S422565. eCollection 2023.

Authors

Xinyue Tu^#¹, Jie Zhang^#², Minjun Li¹, Fei Lu³, Ting Wang³, Wenfeng Gong², Bangde Xiang²

Affiliations

¹ Guangxi Medical University Cancer Hospital, Nanning, 530021, People's Republic of China.
² Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, 530021, People's Republic of China.
³ Department of Radiotherapy, Guangxi Medical University Cancer Hospital, Nanning, 530021, People's Republic of China.

^# Contributed equally.

Abstract

Background: Hepatocellular carcinoma (HCC) patients who are at significant risk of tumor recurrence and mortality can benefit from postoperative adjuvant transarterial chemoembolization (PA-TACE). However, the benefits of PA-TACE remain unclear. Herein, we aimed to develop a model for predicting the prognosis of HBV-related patients who undergo PA-TACE and endeavored to guide individualized clinical treatment.

Methods: We included 432 HBV-related patients who underwent PA-TACE after curative resection were included. The dataset was divided into a training set (n=216) and an internal validation set (n=216). For identifying independent risk factors, the least absolute shrinkage and selection operator and univariate and multivariate Cox analyses were performed. We derived a prognostic model from the training set that was internally validated. The concordance index (C-index), receiver operating characteristic (ROC) curve, calibration curve, and risk stratification were used to evaluate the performance of the nomogram.

Results: Patients undergoing PA-TACE had significantly longer overall survival (OS) than those who did not undergo PA-TACE. Age, albumin levels, macrovascular invasion, tumor size, and, stages of Barcelona Clinic Liver Cancer were identified as independent risk variables and concluded into the nomogram to predict the OS of HBV-related patients who received PA-TACE. The nomogram's C-index values OS were 0.710 and 0.652 in the training and internal validation sets, respectively. Both time-dependent AUC and the calibration curve showed good discrimination and model fitness. The risk score -0.12 was kept as the cut-off value that would accurately divide patients into high-risk and low-risk groups; furthermore, the Kaplan-Meier curve showed a high discriminative ability of the model.

Conclusion: We developed a predictive model. comprising a formula and nomogram to predict the OS and provide risk stratification for HBV-related patients undergoing PA-TACE, which could contribute to suitable treatment options for this patient population.

Keywords: hepatitis B virus; hepatocellular carcinoma; nomogram; prognostic model; transarterial chemoembolization.

Grants and funding

This research was supported by Youth Science Foundation of Guangxi Medical University (GXMUYSF202346), Youth Program of Scientific Research Foundation of Guangxi Medical University Cancer Hospital (2021-08), National Natural Science Foundation of China (81960450) and Medical Science Research Fund of Beijing Medical And Health Foundation (YWJKJJHKYJJ-1322016).