Abstract:

Objective

To investigate the risk factors of recurrence in patients with hepatocellular carcinoma （HCC） within 1 year after TACE，and establish a nomogram prediction model.

Methods

Clinical data of 85 patients newly diagnosed with HCC who underwent transarterial chemoembolization（TACE） for the first time in the Third Affiliated Hospital of Sun Yat-sen University from August 2021 to August 2022 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them，78 patients were male and 7 female，aged （58±12） years on average. According to the China liver cancer （CNLC） staging system，22 patients were classified as CNLC stage Ⅰb，12 cases of stage Ⅱa，24 cases of stage Ⅱb，9 cases of stage Ⅲa and 18 cases of stage Ⅲb，respectively. The tumor diameter was ranged from 1.5 to 19.2 cm，with a median diameter of 6.0 cm. 49 cases had multiple tumors and 36 cases with single tumor. According to patients' situation of short-term recurrence after TACE，all patients were divided into the favorable and poor prognosis groups. Clinical data and detection parameters in two groups were collected. Cox's regression model was used to analyze the influencing factors of short-term prognosis，and R language was adopted to establish the nomograph model.The calibration curve was delineated and internal validation of the prediction model was performed. The area under the receiver operating characteristic （ROC） curve （AUC） was employed to evaluate the predictive value of this model. Decision curve analysis （DCA） was adopted to evaluate the clinical value of this model.

Results

Univariate Cox's regression analysis showed that AFP （HR=5.055，95%CI: 2.224-11.490），liver cirrhosis （HR=6.261，95%CI: 1.862-21.060） and differences of IL-6 levels （HR=0.409，95%CI: 0.171-0.979）and differences of C-reactive protein （CRP） levels （HR=2.905，95%CI: 1.158-7.287） were correlated with short-term recurrence after TACE （P＜0.05）. Multiple Cox's regression analysis showed that AFP≥400 μg/L（HR=3.722，95%CI: 1.543-8.978），liver cirrhosis （HR=4.406，95%CI: 1.249-15.548） and the differences of IL-6 levels≥18.79 pg/ml （HR=0.312，95%CI: 0.119-0.819） and the differences of CRP levels≥36.67 mg/L（HR=4.967，95%CI: 1.895-13.021） were the independent risk factors of short-term recurrence after TACE（P＜0.05）. A nomogram model was drawn based on these independent risk factors. Internal validation of this model showed that the concordance index （C-index） for predicting the recurrence of HCC after TACE was 0.875 （95%CI: 0.842-0.907），and the degree of discrimination was high. ROC curve analysis revealed that the AUC of this model for predicting 1-year recurrence-free survival was 0.794. DCA demonstrated that this model had large net benefit value and relatively high clinical value.

Conclusions

AFP，liver cirrhosis，the differences of IL-6 and CRP levels are the independent risk factors for postoperative short-term recurrence in HCC patients after TACE. Based on these parameters，a nomogram model for predicting postoperative recurrence of HCC is successfully established，which has certain practical value in predicting the recurrence of HCC.

Key words: Carcinoma，hepatocellular, Chemoembolization，therapeutic, Recurrence, Influencing factors, Survival analysis, Prediction model