Abstract
BackgroundAlpha-fetoprotein-negative hepatocellular carcinoma (AFP-NHCC) (< 8.78 ng/mL) have special clinicopathologic characteristics and prognosis. The aim of this study was to apply a new method to establish and validate a new model for predicting the prognosis of patients with AFP-NHCC.MethodsA total of 410 AFP-negative patients with clinical diagnosed with HCC following non-surgical therapy as a primary cohort; 148 patients with AFP-NHCC following non-surgical therapy as an independent validation cohort. In primary cohort, independent factors for overall survival (OS) by LASSO Cox regression were all contained into the nomogram1; by Forward Stepwise Cox regression were all contained into the nomogram2. Nomograms performance and discriminative power were assessed with concordance index (C-index) values, area under curve (AUC), Calibration curve and decision curve analyses (DCA). The results were validated in the validation cohort.ResultsThe C-index of nomogram1was 0.708 (95%CI: 0.673–0.743), which was superior to nomogram2 (0.706) and traditional modes (0.606–0.629). The AUC of nomogram1 was 0.736 (95%CI: 0.690–0.778). In the validation cohort, the nomogram1 still gave good discrimination (C-index: 0.752, 95%CI: 0.691–0.813; AUC: 0.784, 95%CI: 0.709–0.847). The calibration curve for probability of OS showed good homogeneity between prediction by nomogram1 and actual observation. DCA demonstrated that nomogram1 was clinically useful. Moreover, patients were divided into three distinct risk groups for OS by the nomogram1: low-risk group, middle-risk group and high-risk group, respectively.ConclusionsNovel nomogram based on LASSO Cox regression presents more accurate and useful prognostic prediction for patients with AFP-NHCC following non-surgical therapy. This model could help patients with AFP-NHCC following non-surgical therapy facilitate a personalized prognostic evaluation.
Highlights
Alpha-fetoprotein-negative hepatocellular carcinoma (AFP-NHCC) (< 8.78 ng/mL) have special clinicopathologic characteristics and prognosis
The results showed that sex, portal vein tumor thrombus (PVTT), CR, γ-GGT, and C reactive protein (CRP) were independent risk factors for prognosis in patients with AFP-NHCC (Table 2)
Application of the Nomogram model for risk stratification Based on the nomogram1 we developed in this study, we subdivided the patients into low-risk, middle-risk, and high-risk groups, and the patients with AFP-NHCC showed good prognostic classification in both the primary cohort and the validation cohort
Summary
Alpha-fetoprotein-negative hepatocellular carcinoma (AFP-NHCC) (< 8.78 ng/mL) have special clinicopathologic characteristics and prognosis. AFP-NHCC is an important type of liver cancer that currently causes many HCC patients to lose early diagnosis and treatment, especially in HCC with tumors less than 3 cm [6]. Imaging technology has greatly improved the level of HCC detection, ultrasound images often fail to recognize small HCC nodules or distinguish malignant nodules from benign ones [5, 7], and the diagnosis rate for patients with AFP-NHCC is only 10.4% [8]. Studies have shown that patients with AFP-NHCC often have special clinicopathologic characteristics and prognosis, they have higher tumor differentiation, earlier TNM staging, smaller tumor size, and higher survival rates [9]. It is essential to identify the independent prognostic risk factors of such patients, and construct prognostic prediction models
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
