Development and validation of a nomogram to predict the recurrence of hepatocellular carcinoma patients with dynamic changes in AFP undergoing locoregional treatments

Yu Sun; Yiqi Xiong; Qi Wang; Wenying Qiao; Honghai Zhang; Yonghong Zhang

doi:10.3389/fonc.2023.1206345

Development and validation of a nomogram to predict the recurrence of hepatocellular carcinoma patients with dynamic changes in AFP undergoing locoregional treatments

Front Oncol. 2023 Aug 28:13:1206345. doi: 10.3389/fonc.2023.1206345. eCollection 2023.

Authors

Yu Sun¹, Yiqi Xiong¹, Qi Wang¹, Wenying Qiao¹, Honghai Zhang¹, Yonghong Zhang^{1

2}

Affiliations

¹ Interventional Therapy Center for Oncology, Beijing You'an Hospital, Capital Medical University, Beijing, China.
² Research Center for Biomedical Resources, Beijing You'an Hospital, Capital Medical University, Beijing, China.

Abstract

Background: Serum alpha-fetoprotein (AFP) is an important clinical indicator for screening, diagnosis, and prognosis of primary hepatocellular carcinoma (HCC). Our team's previous study showed that patients with negative AFP at baseline and positive AFP at relapse had a worse prognosis (N-P). Therefore, the aim of our study was to develop and validate a nomogram for this group of patients.

Methods: A total of 513 patients with HCC who received locoregional treatments at Beijing You'an Hospital, Capital Medical University, from January 2012 to December 2019 were prospectively enrolled. Patients admitted from 2012 to 2015 were assigned to the training cohort (n = 335), while 2016 to 2019 were in the validation cohort (n =183). The clinical and pathological features of patients were collected, and independent risk factors were identified using univariate and multivariate Cox regression analysis as a basis for developing a nomogram. The performance of the nomogram was evaluated by C-index, receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) curves in the training and validation cohorts.

Results: The content of the nomogram includes gender, tumor number, tumor size, lymphocyte, direct bilirubin (DBIL), gamma-glutamyl transferase (GGT), and prealbumin. The C-index (0.717 and 0.752) and 1-, 3-, and 5-year AUCs (0.721, 0.825, 0.845, and 0.740, 0.868, 0.837) of the training and validation cohorts proved the good predictive performance of the nomogram. Calibration curves and DCA curves suggested accuracy and net clinical benefit rates. The nomogram enabled to classify of patients with dynamic changes in AFP into three groups according to the risk of recurrence: low risk, intermediate risk, and high risk. There was a statistically significant difference in RFS between the three groups in the training and validation cohorts (P<0.001).

Conclusion: The nomogram developed and validated in this study had good predictive power for patients with dynamic changes in AFP.

Keywords: Hepatocellular carcinoma; TACE; ablation; alpha-fetoprotein (AFP); nomogram; recurrence.

Grants and funding

This study was funded by a grant Beijing Municipal Natural Science Foundation (7191004), Capital health development project (2020-1-2182 and 2020-2-1153), Beijing Key Laboratory (BZ0373), Capital’s Funds of Health Improvement and Research (CFH2020-1-2182), Beijing Hospitals Authority Youth Programme (QML20211709), Research and Cultivation Program of Beijing Municipal Hospitals(PX2022067), Key medical professional development plan of Beijing municipal administration of hospitals (ZYLX201711), and Beijing Municipal Administration of Hospitals’ Incubating Program (PX2018059).