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Interactive model for predicting the oncological outcome of patients with early-stage huge hepatocellular carcinoma after hepatectomy: a multicenter population-based study

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Abstract

An interactive model for predicting the oncological outcome of patients with early-stage huge hepatocellular carcinoma (ES-HHCC) after hepatectomy is still lacking. This study was aimed at exploring the independent risk parameters and developing an interactive model for predicting the cancer-specific survival (CSS) of ES-HHCC. Data from patients with ES-HHCC who underwent hepatectomy were collected. The dimensionality of the clinical features was reduced by least absolute shrinkage and selection operator regression and further screened as predictors of CSS by Cox regression. Then, an interactive prediction model was developed and validated. Among the 514 screened patients, 311 and 203 of them were assigned into the training and validation cohort, respectively. Six independent variables, including alpha-fetoprotein, cirrhosis, microvascular invasion, satellite, tumor morphology, and tumor diameter, were identified and incorporated into the prediction model for CSS. The model achieved C-indices of 0.724 and 0.711 in the training and validation cohorts, respectively. Calibration curves showed general consistency in both cohorts. Compared with single predictor, the model had a better performance and greater benefit according to the time-independent receiver operating characteristic curve and decision curve analysis (P < 0.05). The calculator owned satisfactory accuracy and flexible operability for predicting the CSS of ES-HHCC, which could serve as a practical tool to stratify patients with different risks, and guide decision-making.

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Data availability

The data that support the study findings are available upon reasonable request from the corresponding author [Fubao Liu]. The full data are not publicly available due to limitations posed by the ethical regulations at some of the participating centers.

Abbreviations

HCC:

Hepatocellular carcinoma

ES-HHCC:

Early-stage huge hepatocellular carcinoma

CSS:

Cancer-specific survival

OS:

Overall survival

IQR:

Interquartile rangel

ROC:

Receiver operating characteristic

DCA:

Decision curve analysis

C-index:

Concordance index, AUC, Area under the curve

CI:

Confidence interval

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Acknowledgements

We would like to thank Prof. Faming Pan (Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University) for his full access to all the data in the present study and his responsibility for the integrity and accuracy of the data analysis.

Funding

This study was supported by the University Natural Science Research Project of Anhui Province (No. KJ2021ZD0021) & the Postgraduate Innovation Research and Practice Program of Anhui Medical University (YJS20230024). The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Author information

Authors and Affiliations

  1. Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, No.120, Wanshui Road, Hefei, 23022, Anhui, China

    Zixiang Chen, Haonan Sun, Pingchuan Ma, Jiangming Chen, Kejun Hu & Fubao Liu

  2. Department of General Surgery, Chaohu Hospital of Anhui Medical University, Hefei, 238001, Anhui, China

    Kejun Hu

  3. Department of General Surgery, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China

    Hui Hou

  4. Department of General Surgery, The First Affiliated Hospital of University of Science and Technology, Hefei, 230031, Anhui, China

    Jinliang Ma

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  1. Zixiang Chen
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Contributions

FL, XG, ZC. Study design: FL, ZC, JC. Data acquisition: ZC, PM, HS, HH, JM, KH. Quality control of data and algorithms: FL, ZC. Data analysis and interpretation: PM, PM. Statistical analysis: ZC, PM. Manuscript preparation: ZC, FL. Manuscript editing: FL, XG, JC. Manuscript review: FL. Final approval of manuscript: All authors. ZC, HS, PM contributed equally to this work and were considered as co-first authors.

Corresponding author

Correspondence to Fubao Liu.

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Conflict of interest

The authors declare no conflict of interest.

Ethical statement

The study procedures were approved by the institutional ethics committee of the First Affiliated Hospital of Anhui Medical University (No. P-2021-1230).

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Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary Figure 1 Flowchart of patient enrollment

13304_2024_1766_MOESM2_ESM.tif

Supplementary Figure 2 ROC curves of the interactive model for predicting the 1-, 3-, and 5-year CSS of ES-HHCC patients after hepatectomy in the training (A) and validation (B) cohort. ROC, receiver operating characteristic curve. CSS, cancer-specific survival. ES-HHCC, early-stage huge hepatocellular carcinoma.

13304_2024_1766_MOESM3_ESM.tif

Supplementary Figure 3 Time-independent ROC curves of the interactive model for predicting the CSS of ES-HHCC patients after hepatectomy in the training (A) and validation (B) cohort. ROC, receiver operating characteristic curve. CSS, cancer-specific survival. ES-HHCC, early-stage huge hepatocellular carcinoma

13304_2024_1766_MOESM4_ESM.tif

Supplementary Figure 4 DCA of the interactive model for predicting the CSS of ES-HHCC patients after hepatectomy in the training (A) and validation cohort (B). DCA, decision curve analysis. CSS, cancer-specific survival. ES-HHCC, early-stage huge hepatocellular carcinoma

13304_2024_1766_MOESM5_ESM.tif

Supplementary Figure 5 Kaplan–Meier survival curves for risk subgroups of patients estimating the OS of ES-HHCC patients after hepatectomy in the training cohort. OS, overall survival. ES-HHCC, early-stage huge hepatocellular carcinoma

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Chen, Z., Sun, H., Ma, P. et al. Interactive model for predicting the oncological outcome of patients with early-stage huge hepatocellular carcinoma after hepatectomy: a multicenter population-based study. Updates Surg 76, 447–458 (2024). https://doi.org/10.1007/s13304-024-01766-x

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