Establishment and validation of an intratumoral fibrosis-based nomogram for predicting aggressive recurrence after liver resection in hepatocellular carcinoma

Figure 1 Study flowchart. HCC: Hepatocellular carcinoma; LRE: Liver resection; ECOG: Eastern Cooperative Oncology Group.

Figure 2 Sirius red staining of intratumoral fibrosis in hepatocellular carcinoma. A: Representative photomicrograph showing low intratumoral fibrosis expression; B: Representative photomicrograph showing high intratumoral fibrosis expression.

Figure 3 Cumulative incidence of aggressive recurrence stratified by intratumoral fibrosis expression level. A: Training cohort; B: Validation cohort. Comparisons between groups were performed using a two-sided Gray’s test. SHR: Subdistribution hazard ratio; ITF: Intratumoral fibrosis.

Figure 4 Survival analysis of patients with low vs high intratumoral fibrosis before and after inverse probability of treatment weighting. Comparisons between groups were performed using the log-rank test. A: Recurrence-free survival (RFS) before inverse probability of treatment weighting (IPTW) in training cohort; B: RFS after IPTW in training cohort; C: Overall survival (OS) before IPTW in training cohort; D: OS after IPTW in training cohort; E: RFS before IPTW in validation cohort; F: RFS after IPTW in validation cohort; G: OS before IPTW in validation cohort; H: OS after IPTW in validation cohort. HR: Hazard ratio; IPTW: Inverse probability of treatment weighting: ITF: Intratumoral fibrosis.

Figure 5 Nomogram of the competing risk model to predict aggressive recurrence, incorporating intratumoral fibrosis, microvascular invasion, neutrophil count, and tumor size. ITF: Intratumoral fibrosis; MVI: Microvascular invasion.

Figure 6 Performance evaluation of the predictive nomogram. A: Time-dependent receiver operating characteristic curve for 1-year and 2-year aggressive recurrence in the training cohort; B: Time-dependent receiver operating characteristic curve for 1-year and 2-year aggressive recurrence in the validation cohort; C: Calibration plot comparing predicted vs observed probabilities at 1 year and 2 years in the training cohort; D: Calibration plot at 1 year and 2 years in the validation cohort; E: The 1-year and 2-year decision curve analysis curves of the training cohort; F: The 1-year and 2-year decision curve analysis curves of the validation cohort. AUC: Area under the curve.