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. 2023 Apr 19:13:1166327.
doi: 10.3389/fonc.2023.1166327. eCollection 2023.

Development and validation of prognostic dynamic nomograms for hepatitis B Virus-related hepatocellular carcinoma with microvascular invasion after curative resection

Shilei Bai  1 , Pinghua Yang  2 , Yanping Wei  3   4 , Jie Wang  1 , Caixia Lu  1 , Yong Xia  5 , Anfeng Si  6 , Baohua Zhang  2 , Feng Shen  3 , Yexiong Tan  3   4 , Kui Wang  1
Affiliations

Development and validation of prognostic dynamic nomograms for hepatitis B Virus-related hepatocellular carcinoma with microvascular invasion after curative resection

Shilei Bai et al. Front Oncol. .

Abstract

Background and aim: The prediction models of postoperative survival for hepatitis B virus-related hepatocellular carcinoma (HBV-HCC) with microvascular invasion (MVI) have not been well established. The study objective was the development of nomograms to predict disease recurrence and overall survival (OS) in these patients.

Methods: Data were obtained from 1046 HBV-related MVI-positive HCC patients who had undergone curative resection from January 2014 to December 2017. The study was approved by the Eastern Hepatobiliary Surgery Hospital and Jinling Hospital ethics committee, and patients provided informed consent for the use of their data. Nomograms for recurrence and OS were created by Cox regression model in the training cohort (n=530). The modes were verified in an internal validation cohort (n= 265) and an external validation cohort (n= 251).

Results: The nomograms of recurrence and OS based on preoperative serological indicators (HBV-DNA, neutrophil-lymphocyte ratio, a-fetoprotein), tumor clinicopathologic features (diameter, number), surgical margin and postoperative adjuvant TACE achieved high C-indexes of 0.722 (95% confidence interval [CI], 0.711-0.732) and 0.759 (95% CI, 0.747-0.771) in the training cohort, respectively, which were significantly higher than conventional HCC staging systems (BCLC, CNLC, HKLC).The nomograms were validated in the internal validation cohort (0.747 for recurrence, 0.758 for OS) and external validation cohort(0.719 for recurrence, 0.714 for OS) had well-fitted calibration curves. Our nomograms accurately stratified patients with HBV-HCC with MVI into low-, intermediate- and high-risk groups of postsurgical recurrence and mortality. Prediction models for recurrence-free survival (https://baishileiehbh.shinyapps.io/HBV-MVI-HCC-RFS/) and OS (https://baishileiehbh.shinyapps.io/HBV-MVI-HCC-OS/) were constructed.

Conclusions: The two nomograms showed good predictive performance and accurately distinguished different recurrence and OS by the nomograms scores for HBV-HCC patients with MVI after resection.

Keywords: hepatitis B virus; hepatocellular carcinoma; microvascular invasion; nomogram; prognosis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Nomograms for predicting the 1-, 3- and 5-year recurrence (A) and OS (B) rates in patients with HBV-HCC with MVI. OS, overall survival; HCC, hepatocellular carcinoma; NLR, neutrophilto-lymphocyte ratio; TACE, transcatheter arterial chemoembolisation; AFP, alpha-fetoprotein; HBV-DNA, HBV deoxyribonucleic acid.
Figure 2
Figure 2
Time-dependent AUC of using the nomogram to predict recurrence and OS probability within 5 years in the training cohort (A, B),internalvalidation cohorts (C, D) and external validation cohorts (E, F).
Figure 3
Figure 3
The calibration curves of recurrence and OS based on nomogram prediction and actual observation. 1-, 3- and 5-year recurrence and overall survival in the training cohorts (A, B); 1-, 3- and 5-year recurrence and overall survival in the internal validation cohorts (C, D);1-, 3- and 5-year recurrence and overall survival in the external validation cohorts (E, F).
Figure 4
Figure 4
Kaplan-Meier survival curves for patients with different risk of postsurgical recurrence and OS by the nomogram score in training cohorts (A, B), internalvalidation cohorts (C, D) and external validation cohorts (E, F).
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