Construction and Validation of a Novel Nomogram Predicting Recurrence in Alpha-Fetoprotein-Negative Hepatocellular...

Area of Science:

• Hepatocellular Carcinoma Research
• Oncology Biomarkers
• Surgical Oncology Outcomes

Background:

• Hepatocellular carcinoma (HCC) recurrence after resection remains a challenge, particularly in patients with negative alpha-fetoprotein (AFP).
• Predictive models are needed to identify patients at high risk of recurrence for personalized treatment strategies.
• The liver function, nutrition, inflammation, and immunity (LFNII) score is a composite marker reflecting systemic patient health.

Purpose of the Study:

• To develop and validate a nomogram model for predicting recurrence-free survival (RFS) in AFP-negative HCC (AFP-NHCC) patients post-resection.
• To assess the predictive performance of the LFNII score and integrate it into a clinical prediction tool.
• To compare the nomogram's efficacy against existing HCC staging systems.

Main Methods:

• Retrospective analysis of 661 AFP-NHCC patients undergoing resection (2012-2021) from two centers.
• Formulation of the LFNII score using pre-operative blood markers and least absolute shrinkage and selection operator Cox regression.
• Development and validation of a nomogram incorporating LFNII score and clinicopathological factors, assessed by ROC, calibration curves, and decision curve analysis.

Main Results:

• The LFNII score, derived from nine indicators, correlated with unfavorable clinicopathological features.
• The LFNII score demonstrated good predictive efficacy for 1-, 2-, and 5-year RFS (AUCs: 0.675, 0.658, 0.633).
• The LFNII-nomogram model showed a C-index of 0.686 and outperformed standard HCC staging systems in predicting RFS.

Conclusions:

• The LFNII score-based nomogram is an effective tool for predicting RFS in AFP-NHCC patients after curative resection.
• This nomogram can aid in risk stratification and clinical decision-making for AFP-NHCC management.
• The LFNII score offers valuable prognostic information for HCC patients with low AFP levels.