Development and validation of a nomogram for predicting early recurrence in patients undergoing different courses of postoperative adjuvant transarterial chemoembolisation.

Abstract

Background: Hepatocellular carcinoma (HCC) is associated with a high rate of postoperative recurrence. Postoperative adjuvant transcatheter arterial chemoembolization (PA-TACE) is effective in preventing recurrence. However, the effect of different courses of PA-TACE on tumor prognosis remains unclear. As such, this study aimed to develop and validate a nomogram that incorporates different courses of PA-TACE to predict early tumor recurrence.

Methods: Data from 307 high-risk patients who underwent PA-TACE were divided into training and test cohorts at a 6:4 ratio. A nomogram was developed in the training group using least absolute shrinkage and selection operator (LASSO) regression to identify independent prognostic factors and subsequently tested in the test group. Patients were classified into high-, moderate-, and low-risk categories using X-tile software (Rimm Lab, Yale School of Medicine, New Haven, CT, USA), and survival was analyzed.

Results: A nomogram was developed based on independent prognostic factors, including age, tumor diameter, multiplicity, satellite nodules, PA-TACE course, and aspartate transaminase (AST) level. The nomogram demonstrated strong discriminatory power in the training cohort (C-index 0.718, 95% confidence interval [CI]: 0.672-0.763) and validated in a test cohort (C-index 0.759, 95% CI: 0.701-0.817). Calibration and decision curve analyses confirmed predictive accuracy and clinical utility. Kaplan-Meier curves revealed significant discriminatory power among the high-, moderate-, and low-risk groups. No significant differences in PA-TACE-related adverse reactions were observed across the treatment courses, except for allergic reactions.

Conclusion: This study developed and validated a nomogram that accurately predicted the risk for early recurrence after PA-TACE treatment in patients with HCC at a high risk for recurrence. Importantly, the nomogram identified PA-TACE as a key prognostic factor with significant clinical utility.