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. 2025 Feb 20:15:1559083.
doi: 10.3389/fonc.2025.1559083. eCollection 2025.

A novel nomogram based on complement C3 to predict the overall survival of early-stage hepatocellular carcinoma patients with microvascular invasion-positive undergoing curative resection

Guoyi Xia #  1   2 , Zeyan Yu #  1 , Shaolong Lu  1 , Xiaobo Wang  1 , Yuanquan Zhao  3 , Jie Chen  1
Affiliations

A novel nomogram based on complement C3 to predict the overall survival of early-stage hepatocellular carcinoma patients with microvascular invasion-positive undergoing curative resection

Guoyi Xia et al. Front Oncol. .

Abstract

Purpose: This investigation aimed to create a new nomogram based on complement C3 to forecast 1-, 3-, and 5-year overall survival (OS) rates in patients with early-stage hepatocellular carcinoma (HCC) exhibiting microvascular invasion (MVI) post-curative surgery.

Methods: This study encompassed 1234 patients treated with resection at the Affiliated Cancer Hospital of Guangxi Medical University. The cohort for primary included 865 patients from December 2015 to December 2019, while the validation cohort comprised 369 patients. Follow-ups were conducted regularly until December 2024. Variables predicting survival were identified using Cox regression analyses, and based on these, a nomogram was constructed. This nomogram's accuracy was assessed via time-dependent ROC curves, calibration curves and KM curve analyses.

Results: Investigations identified complement C3, PT, the presence of cirrhosis, tumor capsule, and MVI-M2 as distinct predictors of survival in HCC patients. Based on these findings, a predictive nomogram was constructed and validated, aimed at estimating the 1-, 3-, and 5-year OS. The efficacy of the nomogram was validated through analyses with ROC curves, calibration curves, each demonstrating positive outcomes. Additionally, KM curve analysis effectively separated the patient populations into two prognostic risk categories within both the primary and validation cohorts.

Conclusion: In conclusion, a new nomogram has been developed and corroborated through multivariate Cox regression analysis, aimed at estimating overall survival for patients in early stages of microvascular invasion following surgical resection. This tool has proven to be more effective in forecasting survival outcomes for such patients post-curative surgery.

Keywords: curative resection; early-stage; hepatocellular carcinoma; microvascular invasion; overall survival.

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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
Flow chart of patients screening and grouping.
Figure 2
Figure 2
Lasso regression analysis in the primary cohort. (A) Variation features of the coefficient of variables; (B) Determination of the optimal value of λ through cross-validation method.
Figure 3
Figure 3
Nomogram for predicting the 1-, 3-, and 5-year overall survival (OS). C3, complement C3; PT, prothrombin time; MVI, microvascular invasion.
Figure 4
Figure 4
The C-index and time-point roc curves of the nomogram in the primary and validation cohort. (A) The C-index in the primary cohort. (B) The C-index in the validation cohort. (C) The AUCs for OS at 1, 3and 5 years in the primary cohort. (D) The AUCs for OS at 1, 3and 5 years in the validation cohort.
Figure 5
Figure 5
Calibration curves of the nomogram for predicting the 1-, 3-, and 5-year overall survival (OS) in the cohorts. (A) Calibration curves in the primary cohort. (B) Calibration curves in the validation cohort.
Figure 6
Figure 6
Risk stratification for overall survival (OS) based on the nomogram risk scores (A) primary cohort. (B) validation cohort.
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