A clinical-imaging nomogram for predicting posthepatectomy recurrence in hepatocellular carcinoma with microvascular
Shiyuan Huang1, Bin Chen2, Yunyun Wei3
1Hospital Administrative Department, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China.
Purpose:
This study aimed to develop an individualized nomogram incorporating clinical and imaging features to predict recurrence in hepatocellular carcinoma (HCC) patients with microvascular invasion (MVI) after hepatectomy.
Methods:
A total of 317 pathologically confirmed patients with MVI-positive HCC who underwent curative resection between January 2016 and December 2022 were retrospectively analyzed. Independent risk factors for recurrence-free survival (RFS) were identified through univariate and multivariate Cox regression analyzes. A nomogram was developed based on these factors, and its performance was evaluated using the concordance index (C-index), time-dependent receiver operating characteristic curves, and calibration curves. Its clinical utility was assessed using decision curve analysis.
Results:
The developed nomogram incorporated 4 independent predictors for estimating RFS, including MVI grade, alpha-fetoprotein, liver cirrhosis, and smooth tumor margin. The model demonstrated good discriminative ability, with a C-index of 0.758 (95% CI, 0.720-0.803) in the training cohort and 0.702 (95% CI, 0.642-0.790) in the validation cohort. Calibration curves showed good agreement between predictions and observations. When stratified according to the nomogram score, patients in the high-risk group had significantly worse RFS than those in the low-risk group (log-rank P <.0001). Additionally, decision curve analysis demonstrated the clinical utility of the nomogram across a wide range of threshold probabilities.
Conclusion:
The proposed clinical-imaging nomogram provides individualized risk estimates for posthepatectomy recurrence in patients with MVI-positive HCC. This tool facilitates risk stratification, aids clinicians in tailoring postoperative surveillance and adjuvant therapy, and helps identify high-risk patients for timely interventions.
