Prognostic Determinants of Disease-Free Survival After Curative Resection for Hepatocellular Carcinoma: A Retrospective Cohort Study.

Abstract

Introduction: Hepatocellular carcinoma (HCC) is one of the three leading causes of cancer death worldwide today. It is most common in Asia. Liver resection is a curative treatment in the early stages. However, postoperative prognosis varies and data in Southeast Asia are still limited.

Methods: This retrospective descriptive study included 295 patients with hepatocellular carcinoma who underwent curative intent resection at Viet Duc University Hospital between January 2015 and December 2024. Disease-free survival (DFS) was analyzed using the Kaplan-Meier method and compared with the Log rank test. Univariate and multivariate Cox proportional hazards regression analyses were performed to identify prognostic factors. A nomogram integrating clinical and imaging features was constructed and evaluated using receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA).

Results: The median follow-up duration was 60.4 months (1-128 months). The DFS was 35.6 months. Multivariate analysis identified advanced TNM stage (III-IV) (HR 2.562, 95% CI 1.605-4.091, p<0.001), presence of microvascular invasion (HR 1.773, 95% CI 1.295-2.429, p<0.001), positive resection margin (R1) (HR 2.254, 95% CI 1.318-3.857, p=0.003) as independent predictors of poorer DFS, and Child-Pugh B (HR 2.319, 95% CI 1.234-4.356, p=0.009). A prognostic nomogram constructed from these tumor-related factors achieved a concordance index (C-index) of 0.64 (95% CI: 0.60-0.68). Time-dependent ROC analysis demonstrated area under the curve (AUC) values of 0.698, 0.678, and 0.682 at 1, 3, and 5 years, respectively, reflecting acceptable predictive accuracy and favorable calibration.

Conclusion: Advanced tumor stage, microvascular invasion, and positive resection margins are key determinants of disease-free survival after curative resection for hepatocellular carcinoma. A nomogram derived from Vietnamese real-world data may facilitate individualized postoperative risk stratification and surveillance strategies.