Li Wencui, Han Lizhu, Xiao Bohan, Li Xubin, Ye Zhaoxiang
Department of Radiology, Liver Cancer Center, Tianjin Medical University Cancer Institute and Hospital, Huanhu Xi Road, Tiyuan Bei, Hexi District, Tianjin 300060, China.
Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin 300060, China.
Diagnostics (Basel). 2022 Apr 25;12(5):1073. doi: 10.3390/diagnostics12051073.
Background: Alpha-fetoprotein-negative (<20 ng/mL) hepatocellular carcinoma (AFP-NHCC) cannot be easily diagnosed in clinical practice, which may affect early treatment and prognosis. Furthermore, there are no reliable tools for the prediction of AFP-NHCC early recurrence that have been developed currently. The objective of this study was to identify the independent risk factors for AFP-NHCC and construct an individual prediction nomogram of early recurrence of these patients who underwent curative resection. Methods: A retrospective study of 199 patients with AFP-NHCC who had undergone curative resection and another 231 patients with AFP-positive HCC were included in case-controlled analyses. All AFP-NHCC patients were randomly divided into training and validation datasets at a ratio of 7:3. The univariate and multivariate Cox proportional hazards regression analyses were applied to identify the risk factors, based on which the predictive nomogram of early recurrence was constructed in the training dataset. The area under the curve (AUC), calibration curve, and decision curve was used to evaluate the predictive performance and discriminative ability of the nomogram, and the results were validated in the validation dataset. Results: Compared to AFP-positive patients, the AFP-negative group with lower values of laboratory parameters, lower tumor aggressiveness, and less malignant magnetic resonance (MR) imaging features. AST (HR = 2.200, p = 0.009), tumor capsule (HR = 0.392, p = 0.017), rim enhancement (HR = 2.825, p = 0.002) and TTPVI (HR = 5.511, p < 0.001) were independent predictors for early recurrence of AFP-NHCC patients. The nomogram integrated these independent predictors and achieved better predictive performance with AUCs of 0.89 and 0.85 in the training and validation datasets, respectively. The calibration curve and decision curve analysis both demonstrated better predictive efficacy and discriminative ability of the nomogram. Conclusions: The nomogram based on the multivariable Cox proportional hazards regression analysis presented accurate individual prediction for early recurrence of AFP-NHCC patients after surgery. This nomogram could assist physicians in personalized treatment decision-making for patients with AFP-NHCC.
甲胎蛋白阴性（<20 ng/mL）的肝细胞癌（AFP-NHCC）在临床实践中不易诊断，这可能会影响早期治疗和预后。此外，目前尚未开发出用于预测AFP-NHCC早期复发的可靠工具。本研究的目的是确定AFP-NHCC的独立危险因素，并构建接受根治性切除的这些患者早期复发的个体预测列线图。方法：对199例接受根治性切除的AFP-NHCC患者和另外231例AFP阳性肝癌患者进行回顾性研究，并纳入病例对照分析。所有AFP-NHCC患者按7:3的比例随机分为训练集和验证集。应用单因素和多因素Cox比例风险回归分析来识别危险因素，并在此基础上在训练集中构建早期复发的预测列线图。采用曲线下面积（AUC）、校准曲线和决策曲线来评估列线图的预测性能和鉴别能力，并在验证集中对结果进行验证。结果：与AFP阳性患者相比，AFP阴性组的实验室参数值较低、肿瘤侵袭性较低且恶性磁共振（MR）成像特征较少。AST（HR = 2.200，p = 0.009）、肿瘤包膜（HR = 0.392，p = 0.017）、边缘强化（HR = 2.825，p = 0.002）和TTPVI（HR = 5.511，p < 0.001）是AFP-NHCC患者早期复发的独立预测因素。该列线图整合了这些独立预测因素，在训练集和验证集中的AUC分别为0.89和0.85，具有更好的预测性能。校准曲线和决策曲线分析均显示列线图具有更好的预测效能和鉴别能力。结论：基于多变量Cox比例风险回归分析的列线图对AFP-NHCC患者术后早期复发提供了准确的个体预测。该列线图可协助医生为AFP-NHCC患者进行个性化治疗决策。
