Prognostic nomogram for early-stage hepatocellular carcinoma after surgical resection: A Surveillance, Epidemiology, and End Results database-driven risk stratification model
While surgical resection offers favorable outcomes for early-stage hepatocellular carcinoma (HCC) patients, significant postoperative recurrence and prognostic heterogeneity remain, underscoring a lack of reliable predictive tools. Identifying robust prognostic factors is therefore essential for personalized treatment. This study aims to develop and validate a prognostic nomogram for patients with early-stage HCC after surgery using the Surveillance, Epidemiology, and End Results database (2007–2021). We retrospectively analyzed 7,090 patients with early-stage HCC (T1–2N0M0), randomly dividing them into training (n = 4,964) and validation (n = 2,126) cohorts. Key variables were selected using univariate Cox regression and least absolute shrinkage and selection operator regression to mitigate multicollinearity, followed by multivariable Cox regression to construct a model integrating diagnostic year, tumor biology, and treatment parameters. The final nomogram incorporated nine predictive variables: diagnosis year, race, socioeconomic status, tumor size, American Joint Committee on Cancer stage, alpha-fetoprotein level, fibrosis score, surgical approach, and systemic therapy timing. Hepatectomy/liver transplantation was the strongest protective factor (hazard ratio = 0.165; 95% confidence interval [CI]: 0.120–0.228). The model demonstrated strong discrimination, with C-indices of 0.724 (95% CI: 0.710–0.738) in the training cohort and 0.713 (95% CI: 0.691–0.735) in the validation cohort. Time-dependent receiver operating characteristic curves showed areas under the curve exceeding 0.70 for predicting 1-, 3-, and 5-year cancer-specific survival, and calibration plots indicated good agreement between predicted and observed outcomes. Risk stratification using a 150-point cutoff effectively distinguished high-risk patients from low-risk patients, with significantly lower 5-year survival rates (55.0% vs. 88.7%, p < 0.001). In conclusion, this multidimensional nomogram provides a reliable tool for individualized postoperative risk assessment and management in patients with early-stage HCC.
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