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. 2025 Aug;77(4):1113-1119.
doi: 10.1007/s13304-025-02194-1. Epub 2025 May 5.

A nomogram based on PNI and preoperative TACE can predict overall survival in patients with larger than 2 cm HCC after hepatectomy

Huizhi Zhang #  1 , Chunyu Zhang #  1 , Run Hu  1 , Kai Lei  1 , Xingxing Wang  1 , Zuojin Liu  2
Affiliations

A nomogram based on PNI and preoperative TACE can predict overall survival in patients with larger than 2 cm HCC after hepatectomy

Huizhi Zhang et al. Updates Surg. 2025 Aug.

Abstract

This study was to construct a nomogram based on prognostic nutritional index (PNI) and preoperative transcatheter arterial chemoembolization (TACE) to predict the overall survival (OS) of patients with hepatocellular carcinoma (HCC) larger than 2 cm after hepatectomy. 307 and 131 patients were included in the development and validation sets, respectively. The clinical endpoint was OS. Univariate and multivariate Cox regression analyses were used in the development set to screen independent risk factors for clinical endpoints. Independent risk factors were used to construct a nomogram. The C-index, calibration curves, and decision analysis curves were used to evaluate the predictive power of the nomogram in the development and validation sets. After univariate and multivariate Cox regression analysis, independent risk factors for OS included preoperative TACE, age, Barcelona Clinic Liver Cancer (BCLC) stage, PNI, tumor longest diameter, and alpha-fetoprotein (AFP). In the development set and the validation set, the C-index of the nomograms was 0.662 (95% confidence interval (CI): 0.624-0.699) and 0.659 (95% CI: 0.600-0.719), respectively. Calibration curves and decision analysis curves showed that the nomogram had an effective predictive ability. The nomogram based on PNI and preoperative TACE can effectively predict the OS of patients with HCC larger than 2 cm after hepatectomy.

Keywords: Hepatocellular carcinoma (HCC); Nomogram; Overall survival (OS); Prognostic nutritional index (PNI); Transcatheter arterial chemoembolization (TACE).

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Conflict of interest statement

Declarations. Conflict of interest: All authors declare no conflict of interest. Research involving human participants and/or animals: This study was approved by the Ethics Committee of the Second Affiliated Hospital of Chongqing Medical University and written informed consent for publication was obtained from all participants. This study complied with the Declaration of Helsinki. Informed consent: Informed consent was obtained from all patients and this study was approved by the Ethics Committee of the Second Affiliated Hospital of Chongqing Medical University.

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