Risk factors for postoperative prognosis of patients with AFP-negative hepatocellular carcinoma and establishment of a nomogram model

Huiming LI; Yeye WU; Yongqing GUO; Chunmei RAO; Jun LIU; Ling WANG

doi:10.12449/JCH250820

Volume 41 Issue 8

Aug. 2025

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Article Navigation > Journal of Clinical Hepatology > 2025 > 41(8): 1606-1614

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Risk factors for postoperative prognosis of patients with AFP-negative hepatocellular carcinoma and establishment of a nomogram model

DOI: 10.12449/JCH250820

1.
Department of Clinical Laboratory The First Affiliated Hospital of Nanchang University，Nanchang 330006，China
2a.
Second Department of Hepatic Surgery Eastern Hepatobiliary Surgery Hospital，Navy Medical University Shanghai 200438，China
2b.
Department of Clinical Laboratory Eastern Hepatobiliary Surgery Hospital Navy Medical University，Shanghai 200438，China

Research funding:

Key Projects of Jiangxi Provincial Department of Education (GJJ210135);

Health Committee of Jiangxi Province (202310277)

More Information

Corresponding author: WANG Ling， wangling7832@163.com （ORCID： 0000-0002-1613-6805）
Received Date: 2025-02-10
Accepted Date: 2025-03-04
Published Date: 2025-08-25

Abstract

Abstract

Objective To establish dynamic nomogram models for postoperative recurrence and survival risk of patients with AFP-negative hepatocellular carcinoma （ANHC） based on multimodal clinical data， to identify ANHC-specific prognostic biomarker combinations by integrating tumor biological characteristics and treatment response parameters through machine learning， and to provide an individualized risk assessment tool for overcoming the limitations of traditional serum biomarkers. Methods A retrospective analysis was performed for 421 ANHC patients who underwent hepatectomy in Eastern Hepatobiliary Surgery Hospital from April 2012 to December 2018， and they were randomly divided into training group with 210 patients and validation group with 211 patients. The univariate and multivariate Cox proportional-hazards regression models were used to identify independent prognostic factors and establish a nomogram model， and the receiver operating characteristic （ROC） curve， the calibration curve， and the decision curve analysis were used to assess the performance of the model. Related indicators were measured， including prealbumin （PA）， white blood cell count （WBC）， tumor size， and microvascular invasion. The chi-square test or the Fisher’s exact test was used for comparison of categorical variables between two groups， and the independent-samples t test or the Mann-Whitney U test was used for comparison of continuous variables between two groups. Results The multivariate analysis showed that multiple tumors （hazard ratio ［HR］=3.30， P<0.001）， WBC （HR=1.05， P=0.005）， blood glucose （HR=1.15， P=0.026）， CA19-9 （HR=1.17， P=0.005）， and tumor size （HR=1.17， P<0.001） were independent risk factors for disease-free survival （DFS）， while PA （HR=0.99， P=0.022） was a protective factor. Incomplete tumor capsule （HR=0.60， P=0.009）， age （HR=1.02， P=0.035）， prothrombin time （PT）（HR=1.27， P=0.023）， CA19-9 （HR=1.01， P<0.001）， and tumor size （HR=1.15， P<0.001） were independent risk factors for overall survival （OS）. The DFS nomogram achieved an AUC of 0.74 （95% confidence interval ［CI］： 0.64‍‍‍ ‍‍—‍ ‍‍‍0.84） in the training group and 0.67 （95%CI： 0.57 ‍‍—‍ ‍‍‍0.77） in the validation group， while the OS nomogram had an AUC of 0.76 （95%CI： 0.64‍ ‍‍—‍ ‍‍‍0.88） and 0.73 （95%CI： 0.60 ‍‍—‍ ‍‍‍0.87）， respectively. The calibration curve and the decision curve analysis showed that the models had good predictive accuracy and clinical practicability. Conclusion Preoperative indicators， including tumor number， PA， WBC， and tumor size， can effectively predict postoperative recurrence in ANHC patients， while tumor capsule integrity， age， and PT are significantly associated with OS. The nomogram models established have good performance and can provide a basis for individualized prognostic assessment.
- alpha-Fetoproteins,
- Carcinoma， Hepatocellular,
- Nomogram,
- Prognosis

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References

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Risk factors for postoperative prognosis of patients with AFP-negative hepatocellular carcinoma and establishment of a nomogram model

DOI: 10.12449/JCH250820

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