A Clinical-Imaging Nomogram for Predicting Early Recurrence in Patients with Solitary Hepatocellular Carcinoma After Postoperative Adjuvant TACE.

Objective: This study aimed to identify independent predictors of early recurrence (ER) and to establish a clinically applicable, individualized nomogram for patients with solitary hepatocellular carcinoma (HCC) who underwent postoperative adjuvant transarterial chemoembolization (PA-TACE).

Methods: A total of 165 patients with solitary HCC treated with PA-TACE between January 2018 and December 2022 were retrospectively analyzed. Among these patients, 71 experienced ER, while 94 remained recurrence-free for over 24 months. Independent prognostic variables were identified through univariate and multivariate Cox regression analyses. These factors were integrated into a nomogram model, and its performance was evaluated using internal validation and calibration curves.

Results: Multivariate analysis revealed that AFP-L3% >10% (p = 0.009), presence of satellite lesions (p = 0.026), GLR >20 (p = 0.020), microvascular invasion (MVI) (p = 0.008), and Ki-67 expression >50% (p < 0.001) were independently associated with ER. These five variables were used to establish the nomogram, which had a C-index of 0.763 (95% CI: 0.736-0.870).

Conclusion: A nomogram incorporating AFP-L3, satellite lesions, GLR, MVI, and Ki-67 for predicting ER in patients with solitary HCC following PA-TACE was developed and validated. This model exhibits high predictive accuracy and provides a valuable tool for identifying patients who may benefit from PA-TACE.