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Construction and validation of a nomogram for hepatocellular carcinoma patients based on HCC-GRIm score

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Abstract

Purpose

To construct a nomogram for hepatocellular carcinoma (HCC) patients base on HCC-GRIm score.

Methods

Clinical cases of HCC patients diagnosed at Hunan Integrated Traditional Chinese and Western Medicine Hospital were included, and these were randomly divided into the training cohort (n = 219) and the validation cohort (n = 94), and those patients were divided into low GRIm-Score group (scores 0, 1, and 2) and high GRIm-Score group (scores 3, 4, and 5). In the training cohort, independent risk factors were determined by Cox regression analysis, and a nomogram was constructed by independent risk factors. The efficiency and the clinical applicability of nomograms were evaluated using ROC curves, calibration plot, and the decision curve (DCA), and the patients were divided into high-risk, middle-risk, and low-risk groups according to total score of nomogram.

Results

Compared to low HCC-GRIm score group, high HCC-GRIm score group with BCLC stage is more advanced (P < 0.001), and fewer patients received TACE (P = 0.005) and surgical treatment (P = 0.001). There was higher rate of the presence of vascular invasion (P < 0.001) and distant metastasis (P < 0.001). Multivariate Cox regression analysis screened 4 independent risk factors to construct a nomogram of HCC patients, including HCC-GRIm score, BCLC stage, albumin-to-globulin ratio (AGR), and glutamyl trans-peptidase (GGT). The consistency index (C-index) of the nomogram of the training was 0.843 (0.832–0.854) and the validation was 0.870 (0.856–0.885). The time-dependent parameter showed the AUC values of the training cohort at 1, 3, and 5 years were 0.954 (95% CI 0.929–0.980), 0.952 (95% CI 0.919–0.985), and 925 (95% CI 0.871–0.979), while the AUC values of validation cohort at 1, 3, and 5 years were 0.974 (95% CI 0.950–0.998), 0.965 (95% CI 0.931–0.999), and 0.959 (95% CI 0.898–1.021). The calibration plot showed the nomogram fits well onto perfect curves, and the DCA curve showed the net benefit of the nomogram at a certain probability threshold is significantly higher than the net benefit of the BCLC stage at the same threshold probability. Finally, all patients were divided into high-risk, middle-risk, and low-risk groups based on the total score of nomogram, and it showed effectively to identify high-risk patients.

Conclusion

The nomogram constructed by the independent risk factors can predict the prognosis of HCC patients, providing an effective tool with clinical workers to evaluate the prognosis and survival time of HCC patients.

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Availability of data and materials

The data used to support the findings of this study are available from the corresponding author upon request.

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Funding

This work was supported by National Natural Science Foundation of China (82074425, 82205227); Hunan Province Traditional Chinese Medicine Research Program Project (D2022010); Natural Foundation of Hunan Provincial (2021JJ30417); Young Qihuang Scholars Talent Project of National Administration of Traditional Chinese Medicine; Hunan Provincial Health Commission Traditional Chinese Medicine Shennong Leading Talent Project; Hunan Province Science and Technology Top Leading Talent Project.

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Authors and Affiliations

  1. Hunan University of Chinese Medicine, Changsha, 410208, Hunan, China

    Xiaopeng Yu & Renyi Yang

  2. Hunan Academy of Traditional Chinese Medicine Affiliated Hospital, Changsha, 410006, Hunan, China

    Zuomei He, Kexiong Li & Puhua Zeng

  3. Cancer Research Institute of Hunan Academy of Traditional Chinese Medicine, Changsha, 410006, Hunan, China

    Kexiong Li & Puhua Zeng

Authors
  1. Xiaopeng Yu
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  2. Renyi Yang
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  3. Zuomei He
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  4. Kexiong Li
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  5. Puhua Zeng
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Contributions

All authors have access to the data and all drafts of the manuscript. Specific contributions are as follows: The data collection, data management, data analysis, and manuscript drafting: XY. The study design: XY, RY, and KL. The manuscript review: all. Funding sources: PZ, ZH and KL.

Corresponding authors

Correspondence to Kexiong Li or Puhua Zeng.

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The authors declare no competing interests.

Ethical approval and consent to participate

Our Institutional Review Board (Affiliated Hospital of Hunan Academy of Traditional Chinese Medicine) approved this study and waived the need for informed consent from patients.

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The authors declare that they have no competing interests.

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Yu, X., Yang, R., He, Z. et al. Construction and validation of a nomogram for hepatocellular carcinoma patients based on HCC-GRIm score. J Cancer Res Clin Oncol 149, 12013–12024 (2023). https://doi.org/10.1007/s00432-023-05037-x

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  • DOI: https://doi.org/10.1007/s00432-023-05037-x

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