Risk factors and nomogram predictive models for postsurgical progression/hyperprogression recurrence in hepatocellular carcinoma with macroscopic vascular invasion.

Purpose: This study aimed to develop postsurgical progression/hyperprogression recurrence (type III-IV recurrence) prediction models for hepatocellular carcinoma (HCC) patients with macroscopic vascular invasion (MaVI) and to guide treatment strategies in the accurate healthcare era.

Patients and methods: 393 HCC patients with MaVI from two central hospitals made up the entire study population. In developmental (290 patients) and validation (103 patients) cohorts, all patients were randomized into one or the other. Two prediction models for type III-IV recurrence were developed, based on the findings of univariate and multivariate analysis in the development cohort, and multidimensional verification was carried out in both cohorts.

Results: The postoperative recurrence rate of type III-IV in 393 HCC patients with MaVI was 70.9%. Young age, large tumor size (≥ 10 cm), node number, incomplete tumor capsule, postoperative complications, and high Ki67 index were the independent risk factors for relapse of type III-IV. In the development cohort, two nomograms (pre- and postoperative) had the Area Under the ROC curve (AUC) of 0.827 and 0.891, respectively. The two nomograms performed well, according to multidimensional verification methods such as clinical impact curves, decision curve analysis (DCA), and calibration curves. The validation cohort saw similar encouraging results. Both nomograms could separate patients into two distinct prognosis subgroups with ideal cutoff values of 170.3 presurgery and 175.0 postsurgery (both P < 0.05).

Conclusion: We constructed two novel and potentially clinically valuable models for predicting type III-IV recurrence. These two models can develop strategies for treating those suffering from HCC with MaVI owing to their strong prediction performance and availability.