Nomogram Based on Platelet-Albumin-Bilirubin for Predicting Tumor Recurrence After Surgery in Alpha-Fetoprotein-Negative Hepatocellular Carcinoma Patients

Abstract

Purpose: In this study, we developed a nomogram based on the platelet-albumin-bilirubin (PALBI) score to predict recurrence-free survival (RFS) after curative resection in alpha-fetoprotein (AFP)-negative (≤20 ng/mL) hepatocellular carcinoma (HCC) patients.

Patients and methods: A total of 194 pathologically confirmed AFP-negative HCC patients were retrospectively analyzed. Univariate and multivariate Cox regression analyses were performed to screen the independent risk factors associated with RFS, and a nomogram prediction model for RFS was established according to the independent risk factors. The receiver operating characteristic (ROC) curve and the C-index were used to evaluate the accuracy and the efficacy of the model prediction. The correction curve was used to assess the calibration of the prediction model, and decision curve analysis was performed to evaluate the clinical application value of the prediction model.

Results: PALBI score, MVI, and tumor size were independent risk factors for postoperative tumor recurrence (P < 0.05). A nomogram prediction model based on the independent predictive factors was developed to predict RFS, and it achieved a good C-index of 0.704 with an area under the ROC curve of 0.661 and the sensitivity was 73.2%. Patients with AFP-negative HCC could be divided into the high-risk group or the low-risk group by the risk score calculated by the nomogram, and there was a significant difference in RFS between the two groups (P < 0.05). Decision curve analysis (DCA) showed that the nomogram increased the net benefit in predicting the recurrence of AFP-negative HCC and exhibited a wider range of threshold probabilities than the independent risk factors (PALBI score, MVI, and tumor size) by risk stratification.

Conclusion: The nomogram based on the PALBI score can predict RFS after curative resection in AFP-negative HCC patients and can help clinicians to screen out high-risk patients for early intervention.

Keywords: alpha-fetoprotein-negative; hepatocellular carcinoma; nomogram; platelet–albumin–bilirubin score; recurrence-free survival.

Figure 1

Flow chart of the study design.

Figure 2

Relationship of independent risk factors with recurrence-free survival (RFS) in alpha-fetoprotein-negative hepatocellular carcinoma patients. (A) RFS of patients with platelet–albumin-bilirubin (PALBI) scores <-5.95 was longer than that of patients with PALBI scores ≥-5.95. (B) RFS of patients with microvascular invasion (MVI) was longer than that of patients without MVI. (C) RFS of patients with tumor size <5 cm was longer than that of patients with tumor size ≥5 cm.

Figure 3

Development of nomogram prediction model for recurrence-free survival (RFS). (A) Nomogram prediction model. (B) Receiver operating characteristic curve for the nomogram prediction model. (C–E) Calibration curves of the nomogram for predicting 1-, 3-, and 5-year RFS rates.

Figure 4

Prognostic assessment and risk stratification of the nomogram prediction model. (A) Risk stratification for recurrence-free survival (RFS). (B–D) Decision curve analyses of 1-, 3-, and 5-year RFS rates show an increase in net benefit.