Nomogram Based on Platelet–Albumin–Bilirubin for Predicting Tumor Recurrence After Surgery in Alpha-Fetoprotein-Negative Hepatocellular Carcinoma Patients

Abstract

Purpose In this study, we developed a nomogram based on the platelet–albumin–bilirubin (PALBI) score to predict recurrence-free survival (RFS) after curative resection in alpha-fetoprotein (AFP)-negative (≤20 ng/mL) hepatocellular carcinoma (HCC) patients. Patients and Methods A total of 194 pathologically confirmed AFP-negative HCC patients were retrospectively analyzed. Univariate and multivariate Cox regression analyses were performed to screen the independent risk factors associated with RFS, and a nomogram prediction model for RFS was established according to the independent risk factors. The receiver operating characteristic (ROC) curve and the C-index were used to evaluate the accuracy and the efficacy of the model prediction. The correction curve was used to assess the calibration of the prediction model, and decision curve analysis was performed to evaluate the clinical application value of the prediction model. Results PALBI score, MVI, and tumor size were independent risk factors for postoperative tumor recurrence ( P < 0.05). A nomogram prediction model based on the independent predictive factors was developed to predict RFS, and it achieved a good C-index of 0.704 with an area under the ROC curve of 0.661 and the sensitivity was 73.2%. Patients with AFP-negative HCC could be divided into the high-risk group or the low-risk group by the risk score calculated by the nomogram, and there was a significant difference in RFS between the two groups ( P < 0.05). Decision curve analysis (DCA) showed that the nomogram increased the net benefit in predicting the recurrence of AFP-negative HCC and exhibited a wider range of threshold probabilities than the independent risk factors (PALBI score, MVI, and tumor size) by risk stratification. Conclusion The nomogram based on the PALBI score can predict RFS after curative resection in AFP-negative HCC patients and can help clinicians to screen out high-risk patients for early intervention.

Construction and Validation of a Novel Nomogram Predicting Recurrence in Alpha-Fetoprotein-Negative Hepatocellular Carcinoma Post-Surgery Using an Innovative Liver Function-Nutrition-Inflammation-Immune (LFNII) Score: A Bicentric Investigation

“…Numerous inflammatory, nutritional, and immune indicators, including GAR, GAPR, AAR, ALBI, LMR, NrLR, CRP, and PALBI, have been linked to the prognosis of patients with AFP-NHCC. 24 , 27–29 , 31 However, these individual indices are insufficient for patient risk stratification. Previous studies have demonstrated the prognostic efficacy of a composite score combining inflammation, immunity, and nutrition in intrahepatic cholangiocarcinoma; 47 however, such a study is lacking in HCC.…”

“…Numerous inflammatory, nutritional, and immune indicators, including GAR, GAPR, AAR, ALBI, LMR, NrLR, CRP, and PALBI, have been linked to the prognosis of patients with AFP-NHCC. 24,[27][28][29]31 However, these formulated LFNII scores incorporated these nine indicators. Earlier studies identified ANRI, ALRI, AAPR, SII, and SIRI as indicators of inflammatory immune status in patients.…”

“…These three indicators were neutrophil times γ-glutamyl transpeptidase to lymphocyte ratio (NrLR), 30 γ-glutamyl transpeptidase to lymphocyte count ratio (GLR), 28 and platelet-albumin-bilirubin (PALBI) score. 31 The predictive ability of the four indicators for postoperative recurrence and the degree of clinical benefit were compared using time-dependent AUC analysis and clinical decision assessment. Simultaneously, to broaden the clinical application of the LFNII score, we incorporated it into the AFP-positive cohort for analysis.…”