Pre- to postoperative alpha-fetoprotein ratio-based nomogram to predict tumor recurrence in patients with hepatocellular carcinoma

Abstract

BackgroundThis study aimed to investigate the role of the alpha fetoprotein (AFP) ratio before and after curative resection in the prognosis of patients with hepatocellular carcinoma (HCC) and to develop a novel pre- to postoperative AFP ratio nomogram to predict recurrence free survival (RFS) for HCC patients after curative resection.MethodsA total of 485 pathologically confirmed HCC patients who underwent radical hepatectomy from January 2010 to December 2018 were retrospectively analyzed. The independent prognostic factors of hepatocellular carcinoma were identified by multivariate COX proportional model analysis, and the nomogram model was constructed. The receiver operating characteristic and the C-index were used to evaluate the accuracy and efficacy of the model prediction, the correction curve was used to assess the calibration of the prediction model, and decision curve analysis was used to evaluate the clinical application value of the nomogram model.ResultsA total of 485 HCC patients were divided into the training cohort (n = 340) and the validation cohort (n = 145) by random sampling at a ratio of 7:3. Using X-tile software, it was found that the optimal cut-off value of the AFP ratio in the training cohort was 0.8. In both cohorts, the relapse-free survival of patients with an AFP ratio <0.8 (high-risk group) was significantly shorter than in those with an AFP ratio ≥0.8 (low-risk group) (P < 0.05). An AFP ratio <0.8 was an independent risk factor for recurrence of HCC after curative resection. Based on the AFP ratio, BCLC stage and cirrhosis diagnosis, a satisfactory nomogram was developed. The AUC of our nomogram for predicting 1-, 3-, and 5-year RFS was 0.719, 0.690, and 0.708 in the training cohort and 0.721, 0.682, and 0.681 in the validation cohort, respectively. Furthermore, our model demonstrated excellent stratification as well as clinical applicability.ConclusionThe AFP ratio was a reliable biomarker for tumor recurrence. This easy-to-use AFP ratio-based nomogram precisely predicted tumor recurrence in HCC patients after curative resection.

Establishing and Externally Validating a Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) Score-Based Nomogram for Predicting Early Recurrence in BCLC Stage 0/A Hepatocellular Carcinoma Patients After Radical Liver Resection: A Multi-Center Study

“… 24 However, due to the varying criteria for patient selection, existing prognostic models often encompass a wide range of tumor stages, including advanced stages such as BCLC stage C and TNM stage IV, which has made it challenging to use a single model to accurately evaluate the prognosis of patients with early-stage HCC. 9 , 11 , 25 Therefore, developing a specialized model to predict the prognosis of BCLC stage 0/A HCC patients is of great significance.…”

“…However, they encompass a broad spectrum of tumor stages, including advanced stages such as BCLC stage C and TNM stage IV, leading to imprecise prognostic predictions for patients with early-stage HCC. [8][9][10][11] Hence, there is a pressing need to develop a specialized prediction model specifically for patients with BCLC stage 0/A HCC.…”

Possible Therapies for Hepatocellular Carcinoma—Preparing for the Modern War with the Insidious Enemy

“…While the alpha-fetoprotein (AFP) marker may hold some diagnostic importance, its limited specificity and sensitivity in HCC, not exceeding 50–60%, prevents its use as a primary diagnostic tool [ 1 ]. Nevertheless, it can help assess the risk of poor prognosis and disease recurrence after surgical treatment [ 1 , 11 ].…”

“…in the dedicated HCC centers [ 1 , 13 ]. Surgical treatment—R0 resection with a margin of normal tissue (considering the area of portal vein vasculature next to the HCC lesion) or liver transplantation within the Milan criteria—has remained the only possible radical treatment for early stage HCC for many years [ 1 , 11 ]. Patients who are optimal candidates for this potentially radical surgery have a 5 year OS rate of 60–80%.…”