Development and validation of a prognostic prediction model for alpha-fetoprotein-negative hepatocellular carcinoma with microvascular invasion after surgery

doi:10.3748/wjg.123092

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World Journal of Gastroenterology

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1007-9327

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Copyright: ©Author(s) 2027. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastroenterol. Jan 14, 2027; 33(2): 123092
Published online Jan 14, 2027. doi: 10.3748/wjg.123092

Table 1 Comparison of clinicopathological characteristics of two groups’ patients, mean ± SD/ median (interquartile range)

Parameter	Total patients (n = 251)	Training cohort (n = 135)	Validation cohort (n = 116)	P value
Age (years)	53.92 ± 11.19	53.36 ± 10.97	54.57 ± 11.45	0.264
Gender: Female/male	25/226	11/124	14/102	0.301
Alcohol abuse: No/yes	131/120	71/64	60/56	0.891
Smoking: No/yes	156/95	80/55	76/40	0.308
FHC: No/yes	232/19	124/11	108/8	0.709
HBsAg: Negative/positive	57/194	29/106	28/88	0.616
Liver cirrhosis: No/yes	31/220	15/120	16/100	0.520
Tumor size (cm)	8.47 ± 4.84	8.55 ± 4.85	8.38 ± 4.84	0.890
TN: Single/multiple	115/136	67/68	48/68	0.191
TBS	7.60 ± 4.51	7.74 ± 4.48	7.43 ± 4.57	0.868
Child-Pugh class: A/B	200/51	107/28	93/23	0.858
BCLC stage: 0-A/B-C	102/149	56/79	46/70	0.769
WBC (× 10⁹/L)	6.29 ± 1.93	6.30 ± 1.83	6.27 ± 2.04	0.057
NEUT (× 10⁹/L)	3.81 ± 1.75	3.94 ± 1.67	3.66 ± 1.83	0.339
LYMPH (× 10⁹/L)	1.61 ± 0.57	1.63 ± 0.53	1.60 ± 0.62	0.059
Platelets (× 10⁹/L)	181.43 ± 77.95	182.72 ± 76.59	179.94 ± 79.83	0.211
Fibrinogen (g/L)	3.14 ± 1.44	3.09 ± 1.72	3.21 ± 1.02	0.412
Albumin (g/L)	38.42 ± 6.12	38.23 ± 4.75	38.63 ± 7.42	0.104
Globulin (g/L)	30.97 ± 5.76	30.95 ± 5.63	30.98 ± 5.93	0.740
TBIL (μmol/L)	11.70 (8.65-15.24)	12.65 (8.78-16.00)	10.76 (8.32-14.90)	0.119
DBIL (μmol/L)	4.70 (3.49-5.90)	4.79 (3.60-6.00)	4.68 (3.40-5.70)	0.781
ALT (U/L)	31.24 (20.80-49.90)	34.70 (23.36-54.90)	26.85 (17.47-44.30)	0.202
AST (U/L)	35.90 (25.50-53.01)	38.70 (26.70-64.90)	32.95 (24.72-45.57)	0.246
GGT (U/L)	77.61 (43.40-145.80)	82.28 (51.90-145.80)	70.69 (38.21-146.51)	0.606
GMWG	23.67 ± 9.60	24.20 ± 9.47	23.06 ± 9.74	0.557
NLR	2.57 ± 1.43	2.62 ± 1.32	2.52 ± 1.56	0.358
Early recurrence: No/yes	133/118	67/68	66/50	0.250

FHC: Family history of cancer; HBsAg: Hepatitis B surface antigen; TN: Tumor number; TBS: Tumor burden score; BCLC: Barcelona Clinic Liver Cancer; WBC: White blood cell; NEUT: Neutrophil cell count; LYMPH: Lymphocyte; TBIL: Total bilirubin; DBIL: Direct bilirubin; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; GGT: Gamma-glutamyl transpeptidase; GMWG: Geometric mean of gamma-glutamyl transpeptidase and white blood cell; NLR: Neutrophil to lymphocyte ratio.

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Table 2 Univariate Cox regression analysis of overall survival in the training cohort

Variable	HR	95%CI	P value
Gender (male vs female)	0.877	0.381-2.017	0.758
Age, years (> 55 vs ≤ 55)	0.921	0.590-1.437	0.716
Alcohol abuse (yes vs no)	1.127	0.727-1.747	0.593
Smoking (yes vs no)	1.264	0.895-2.036	0.076
HBsAg (positive vs negative)	1.078	0.631-1.842	0.784
Liver cirrhosis (yes vs no)	1.248	0.584-2.663	0.567
TN (multiple vs single)	1.235	0.720-2.116	0.417
TBS (> 8.0 vs ≤ 8.0)	3.037	1.962-4.539	< 0.001
BCLC (B-C vs 0-A)	2.015	1.201-3.380	0.008
Fibrinogen, g/L (> 3.0 vs ≤ 3.0)	1.591	1.025-2.468	0.038
AST, U/L (> 40 vs ≤ 40)	0.832	0.488-1.525	0.611
GMWG (> 22.7 vs ≤ 22.7)	2.634	1.677-4.138	< 0.001
NLR (> 2.3 vs ≤ 2.3)	2.844	1.747-4.230	< 0.001

HR: Hazard ratio; CI: Confidence interval; HBsAg: Hepatitis B surface antigen; TN: Tumor number; TBS: Tumor burden score; BCLC: Barcelona Clinic Liver Cancer; AST: Aspartate aminotransferase; GMWG: Geometric mean of gamma-glutamyl transpeptidase and white blood cell; NLR: Neutrophil to lymphocyte ratio.

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Table 3 Multivariable Cox regression analysis of overall survival in the training cohort

Variable	β-estimate (95%CI)	HR (95%CI)	P value
TBS (> 8.0 vs ≤ 8.0)	1.002 (0.503-1.501)	2.724 (1.654-4.486)	< 0.001
BCLC (B-C vs 0-A)		1.606 (0.915-2.817)	0.099
Fibrinogen, g/L (> 3.0 vs ≤ 3.0)		0.752 (0.459-1.230)	0.256
GMWG (> 22.7 vs ≤ 22.7)	0.586 (0.106-1.067)	1.797 (1.112-2.906)	0.017
NLR (> 2.3 vs ≤ 2.3)	0.775 (0.259-1.290)	2.170 (1.296-3.634)	0.003

TGN score = 1.002 × tumor burden score (0: ≤ 8.0; 1: > 8.0) + 0.586 × geometric mean of gamma-glutamyl transpeptidase and white blood cell (0: ≤ 22.7; 1: > 22.7) + 0.775 × neutrophil to lymphocyte ratio (0: ≤ 2.3; 1: > 2.3). Cut-offs to generate the risk groups: ≤ 0.6 (low), > 0.6 to ≤ 1.7 (intermediate), > 1.7 (high). HR: Hazard ratio; CI: Confidence interval; TBS: Tumor burden score; BCLC: Barcelona Clinic Liver Cancer; GMWG: Geometric mean of gamma-glutamyl transpeptidase and white blood cell; NLR: Neutrophil to lymphocyte ratio.

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Citation: Liao MJ, Zhou Y, Wang ZL, Wang XX, Ai X, Song LN, Fei R, Cong X, Liu F, Zhu PP, Chen HS, Liao WJ, Rao HY. Development and validation of a prognostic prediction model for alpha-fetoprotein-negative hepatocellular carcinoma with microvascular invasion after surgery. World J Gastroenterol 2027; 33(2): 123092
URL: https://www.wjgnet.com/1007-9327/full/v33/i2/123092.htm
DOI: https://dx.doi.org/10.3748/wjg.123092

Liao MJ, Zhou Y, Wang ZL, Wang XX, Ai X, Song LN, Fei R, Cong X, Liu F, Zhu PP, Chen HS, Liao WJ, Rao HY. Development and validation of a prognostic prediction model for alpha-fetoprotein-negative hepatocellular carcinoma with microvascular invasion after surgery. World J Gastroenterol 2027; 33(2): 123092 [DOI: 10.3748/wjg.123092]

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