Abstract
Purpose
The objective of this study was to develop and validate a novel prognostic nomogram to evaluate the survival benefit of hepatocellular carcinoma (HCC) patients receiving postoperative adjuvant transarterial chemoembolization (PA-TACE).
Materials and methods
Clinical data of HCC patients who underwent hepatectomy at four medical centers were retrospectively analyzed, including those who received PA-TACE and those who did not. These two categories of patients were randomly allocated to the development and validation cohorts in a 7:3 ratio.
Results
A total of 1505 HCC patients who underwent hepatectomy were included in this study, comprising 723 patients who did not receive PA-TACE and 782 patients who received PA-TACE. Among them, patients who received PA-TACE experienced more adverse events, although these events were mild and manageable (Grade 1–2, all p < 0.05). Nomograms were constructed and validated for patients with and without PA-TACE using independent predictors that influenced disease-free survival (DFS) and overall survival (OS). These two nomograms had C-indices greater than 0.800 in the development cohort and exhibited good calibration and discrimination ability compared to six conventional HCC staging systems. Patients in the intermediate-to-high-risk group in the nomogram who received PA-TACE had higher DFS and OS (all p < 0.05). In addition, tumor recurrence was significantly controlled in the intermediate-to-high-risk group of patients who received PA-TACE, while there was no significant difference in the low-risk group of patients who received PA-TACE.
Conclusion
The nomograms were developed and validated based on large-scale clinical data and can serve as online decision-making tools to predict survival benefits from PA-TACE in different subgroups of patients.





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Data availability
Data will be made available on reasonable request due to restrictions, e.g., privacy or ethical.
Abbreviations
- HCC:
-
Hepatocellular carcinoma
- PA-TACE:
-
Postoperative adjuvant transcatheter chemoembolization
- EASL:
-
European Association for the study of the liver
- AASLD:
-
American Association for the study of liver diseases
- APASL:
-
Asian Pacific Association for the study of the liver
- AFP:
-
Alpha-fetoprotein
- ALT:
-
Alanine aminotransferase
- AST:
-
Aspartate aminotransferase
- GGT:
-
Gamma-glutamyltransferase
- ALP:
-
Alkaline phosphatase
- ALB:
-
Albumin
- TB:
-
Total bilirubin
- WBC:
-
White blood cell
- CR:
-
Creatinine
- PT:
-
Prothrombin time
- NLR:
-
Neutrophil-to-lymphocyte ratio
- LMR:
-
Lymphocyte-to-monocyte ratio
- PLR:
-
Platelet-to-lymphocyte ratio
- HBV:
-
Hepatitis B virus
- MVI:
-
Microvascular invasion
- CT:
-
Computed tomography
- MRI:
-
Magnetic resonance imaging
- DFS:
-
Disease-free survival
- OS:
-
Overall survival
- ROC:
-
Receiver operating characteristic
- AUC:
-
Area under the curve
- C-Index:
-
Concordance index
- HR:
-
Hazard ratio
- Cl:
-
Confidence interval
- CNLC:
-
China liver cancer
- BCLC:
-
Barcelona clinic liver cancer
- AJCC:
-
American joint committee on cancer
- TNM:
-
Tumor node metastasis
- JIS:
-
Japan integrated staging
- HKLC:
-
Hong Kong liver cancer
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Funding
This work was funded by Zhongshan Science and Technology Plan Project of Guangdong Province (Project Number: 2021B1040), Key research and development projects of Jiangxi Provincial Department of Science and Technology (Project Number: 20202BBGL73092), Natural Science Foundation of Jiangxi Provincial (Project Number: 20171BAB205064) and National Natural Science Foundation of China (Project Number: 81860432) that have no role in the collection, analysis, interpretation of results or writing of the manuscripts.
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KH and YL contributed to the study concept and design. YH, JQ, GZ, and ZW were involved in the conceptualization of methodology. YH, JQ, GZ, ZW, LC, ST, LL, and RS assisted in the acquisition of data. YH, JQ, GZ, and ZW contributed to the analysis and interpretation of data. YH, JQ, GZ, ZW, KH, and YL were involved in the drafting of the manuscript.
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The study was approved by the ethics committees of the First Affiliated Hospital of Nanchang University, the Second Affiliated Hospital of Nanchang University, Shenzhen People's Hospital and Zhongshan People's Hospital, and followed the guidelines of the Declaration of Helsinki (Ethics number:2022-CDYFYYLK-08–015). Written informed consent was obtained from all patients for their data to be used for scientific purposes.All procedures involving human participants were performed in accordance with the 1975 Helsinki declaration and its lateramendments.
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He, Y., Qian, J., Zhu, G. et al. Development and validation of nomograms to evaluate the survival outcome of HCC patients undergoing selective postoperative adjuvant TACE. Radiol med 129, 653–664 (2024). https://doi.org/10.1007/s11547-024-01792-0
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DOI: https://doi.org/10.1007/s11547-024-01792-0