Background
Methods
Patients
Clinical parameters | Training cohort (n = 482) | Validation cohort (n = 216) | P |
---|---|---|---|
Gender (male/female) | 404 (83.8%)/78 (16.2%) | 185 (85.6%)/31 (14.4%) | 0.538 |
Age (> 60/ ≤ 60 years) | 369 (76.6%)/113 (23.4%) | 162 (75.0%)/54 (25.0%) | 0.376 |
HBsAg (positive/negative) | 417 (86.5%)/65 (13.5%) | 187 (87.0%)/29 (13.0%) | 0.868 |
HBV-DNA (≥ 103/ < 103 copies/mL) | 261 (54.2%)/221 (45.8%) | 107 (49.5%)/109 (50.5%) | 0.282 |
HBeAg (positive/negative) | 97 (20.1%)/385 (79.9%) | 45 (21.0%)/171 (79.0%) | 0.323 |
AFP (< 20/20–400/ > 400 ng/mL) | 157 (32.6%)/119 (24.7%)/206 (42.7%) | 68 (31.6%)/54 (25.1%)/94 (43.3%) | 0.966 |
NEU (> 3.56/ ≤ 3.56 × 109/L) | 228 (47.4%)/254 (52.6%) | 99 (46.0%)/117 (54.0%) | 0.741 |
LYM (> 1.1/ ≤ 1.1 × 109/L) | 362 (75.1%)/120 (24.9%) | 171 (79.1%)/45 (20.9%) | 0.255 |
PLT (> 100/ ≤ 100 × 109/L) | 351 (72.8%)/131 (27.2%) | 143 (66.2%)/73 (33.8%) | 0.076 |
NLR (> 3/ ≤ 3) | 153 (31.8%)/329 (68.2%) | 47 (21.9%)/169 (78.1%) | 0.007 |
PLR (> 111/ ≤ 111) | 180 (37.3%)/302 (62.7%) | 59 (27.4%)/157 (72.6%) | 0.011 |
TBIL (> 28/ ≤ 28 μmol/L) | 15 (3.1%)/467 (96.9%) | 8 (3.7%)/208 (96.3%) | 0.689 |
ALT (> 50/ ≤ 50 IU/L) | 161 (33.4%)/321 (66.6%) | 76 (35.2%)/140 (64.8%) | 0.646 |
AST (> 40/ ≤ 40 IU/L) | 216 (44.8%)/266 (55.2%) | 101 (46.8%)/115 (53.2%) | 0.633 |
ALB (> 40/ ≤ 40 g/L) | 308 (63.9%)/174 (36.1%) | 131 (60.6%)/85 (39.4%) | 0.411 |
ALBI grade (1/2/3) | 343 (71.2%)/139 (28.8%)/0 (0%) | 136 (62.8%)/80 (37.2%)/0 (0%) | 0.025 |
GGT (> 60/ ≤ 60 IU/L) | 240 (49.8%)/242 (50.2%) | 114 (52.8%)/102 (47.2%) | 0.466 |
PT (> 12.8/ ≤ 12.8 s) | 119 (24.7%)/363 (75.3%) | 39 (17.9%)/177 (82.1%) | 0.344 |
INR (> 1.15/ ≤ 1.15) | 101 (21.0%)/381 (79.0%) | 50 (23.1%)/166 (76.9%) | 0.515 |
Fib (> 2/ ≤ 2 g/L) | 401 (83.2%)/81 (16.8%) | 173 (79.9%)/43 (20.1%) | 0.338 |
Tumor diameter (≤ 5/5–10/ > 10 cm) | 219 (45.4%)/199 (41.2%)/65 (13.4%) | 105 (48.4%)/89 (41.2%)/29 (13.4%) | 0.531 |
Tumor number (1/2/3) | 402 (83.4%)/58 (12.0%)/22 (4.6%) | 170 (78.6%)/37 (17.2%)/9 (4.2%) | 0.284 |
BCLC stage (A/B) | 409 (84.9%)/73 (15.1%) | 178 (82.3%)/38 (17.7%) | 0.399 |
Cirrhosis (present/absent) | 296 (61.4%)/186 (38.6%) | 153 (70.8%)/63 (29.2%) | 0.016 |
Differentiation (I + II/III + IV) | 279 (57.9%)/203 (42.1%) | 123 (56.9%)/93 (43.1%) | 0.816 |
MVI (present/absent) | 204 (42.3%)/278 (57.7%) | 86 (39.8%)/130 (60.2%) | 0.534 |
Satellite lesion (present/absent) | 72 (14.9%)/410 (85.1%) | 31 (14.4%)/185 (85.6%) | 0.840 |
Resection (anatomic/non-anatomic) | 250 (51.9%)/232 (48.1%) | 110 (50.9%)/106 (49.1%) | 0.818 |
Surgery
Follow-up
Statistical analysis
Results
Patient characteristics
Independent predictors of early recurrence
Clinical parameters | OR (95% CI) | P |
---|---|---|
Gender (male/female) | 1.27 (1.043–1.545) | 0.017 |
Age (> 60/ ≤ 60 years) | 0.596 (0.480–0.740) | < 0.001 |
HBsAg (positive/negative) | 1.262 (1.075–1.482) | 0.004 |
HBV-DNA (≥ 103/< 103 copies/mL) | 1.529 (1.164–2.010) | 0.002 |
HBeAg (positive/negative) | 1.771 (1.170–2.681) | 0.007 |
AFP | ||
(< 20/20–400 ng/mL) | 1.337 (1.171–1.527) | < 0.001 |
(< 20/ > 400 ng/mL) | 1.582(1.277–1.960) | < 0.001 |
NEU (> 3.56/ ≤ 3.56 × 109/L) | 1.621 (1.241–2.117) | < 0.001 |
LYM (> 1.1/ ≤ 1.1 × 109/L) | 1.221 (0.993–1.502) | 0.059 |
PLT (> 100/ ≤ 100 × 109/L) | 1.472 (1.189–1.821) | < 0.001 |
NLR (> 3/ ≤ 3) | 2.000 (1.429–2.799) | < 0.001 |
PLR (> 111/ ≤ 111) | 1.687 (1.247–2.282) | 0.001 |
TB (> 28/ ≤ 28 μmol/L) | 2.000 (0.684–5.581) | 0.206 |
ALT (> 50/ ≤ 50 IU/L) | 1.368 (1.000–1.870) | 0.05 |
AST (> 40/ ≤ 40 IU/L) | 1.602 (1.218–2.108) | 0.001 |
ALB (> 40/ ≤ 40 g/L) | 1.184 (0.947–1.482) | 0.139 |
ALBI grade (1/2/3) | 0.781 (0.523–1.168) | 0.229 |
GGT (> 60/ ≤ 60 IU/L) | 1.697 (1.306–2.205) | < 0.001 |
PT (> 12.8/ ≤ 12.8 s) | 1.164 (0.812–1.668) | 0.41 |
INR (> 1.15/ ≤ 1.15) | 1.244 (0.841–1.842) | 0.275 |
Fib (> 2/ ≤ 2 g/L) | 1.079 (0.873–1.335) | 0.482 |
Tumor size | ||
(≤ 5/5–10 cm) | 3.279 (2.189–4.910) | < 0.001 |
(≤ 5/ > 10 cm) | 2.031 (1.497–2.755) | < 0.001 |
Tumor number | ||
(1/2) | 2.295 (1.262–4.174) | 0.007 |
(1/3) | 2.069 (1.193–3.588) | 0.010 |
BCLC stage (A/B) | 3.056 (1.795–5.203) | < 0.001 |
Cirrhosis (present/absent) | 1.193 (0.949–1.499) | 0.131 |
Differentiation (I + II/III + IV) | 1.819 (1.365–2.426) | < 0.001 |
MVI (present/absent) | 2.923 (2.133–4.005) | < 0.001 |
Satellite lesion (present/absent) | 2.429 (1.461–4.037) | 0.001 |
Resection (anatomic/non-anatomic) | 1.475 (1.146–1.899) | 0.003 |
Clinical parameters | OR (95% CI) | P |
---|---|---|
Preoperative | ||
Age (> 60/ ≤ 60 years) | 0.984 (0.987–0.990) | < 0.001 |
AFP | ||
(< 20/20–400 ng/mL) | 1.508 (1.180–1.928) | 0.001 |
(< 20/ > 400 ng/mL) | 1.627 (1.171–2.260) | 0.004 |
Tumor diameter | ||
(≤ 5/5–10 cm) | 2.862 (1.753–4.673) | < 0.001 |
(≤ 5/ > 10 cm) | 1.699 (1.148–2.513) | 0.008 |
Tumor number | ||
(1/2) | 2.540 (1.168–5.523) | 0.019 |
(1/3) | 2.399 (1.061–5.420) | 0.035 |
Postoperative | ||
Age (> 60/ ≤ 60 years) | 0.981 (0.975–0.987) | < 0.001 |
Tumor diameter (≤ 5/5–10/ > 10 cm) | ||
(≤ 5/5–10 cm) | 2.835 (1.823–4.408) | < 0.001 |
(≤ 5/ > 10 cm) | 1.717 (1.198–2.462) | 0.003 |
Tumor number (1/2/3) | ||
(1/2) | 1.955 (1.247–3.065) | 0.003 |
(1/3) | 2.084 (1.026–4.232) | 0.042 |
Differentiation (I + II/III + IV) | 1.580 (1.059–2.358) | 0.025 |
MVI (present/absent) | 2.904 (1.914–4.405) | < 0.001 |
Construction of pre- and postoperative nomograms for predicting early recurrence
Validation of the prediction models
The predictive ability of the nomograms
Variables | Preoperative nomogram | Postoperative nomogram | ||
---|---|---|---|---|
Training cohort (482) | Validation cohort (216) | Training cohort (482) | Validation cohort (216) | |
AUC | 0.721 (0.684–0.759) | 0.754 (0.690–0.817) | 0.848 (0.814–0.883) | 0.844 (0.790–0.897) |
Cut-off score | 88 | 88 | 110 | 110 |
Sensitivity | 0.611 (0.567–0.654) | 0.642 (0.578–0.706) | 0.706 (0.665–0.747) | 0.679 (0.617–0.741) |
Specificity | 0.716 (0.676–0.756) | 0.76 (0.703–0.817) | 0.802 (0.766–0.838) | 0.800 (0.746–0.853) |
Positive predictive value | 0.704 (0.663–0.745) | 0.77 (0.714–0.826) | 0.793 (0.756–0.829) | 0.764 (0.707–0.821) |
Negative predictive value | 0.587 (0.543–0.631) | 0.629 (0.565–0.693) | 0.724 (0.684–0.764) | 0.699 (0.638–0.760) |
Positive likelihood ratio | 2.151 (2.011–2.291) | 2.675 (2.393–2.957) | 3.564 (3.294–3.834) | 3.394 (3.014–3.774) |
Negative likelihood ratio | 0.543 (0.499–0.587) | 0.471 (0.404–0.538) | 0.367 (0.324–0.411) | 0.401 (0.336–0.466) |