Clinicopathological predictors and an internally validated exploratory nomogram for 2-year recurrence after hepatic resection of hepatocellular carcinoma ≤5 cm.
- 1Department of Hepatobiliary Surgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China.
Abstract
Background
Recurrence remains common after resection of hepatocellular carcinoma (HCC) even when tumor diameter is limited. We evaluated routinely available clinicopathological predictors of recurrence within 2 years after resection of HCC ≤5 cm and developed an exploratory nomogram with bootstrap internal validation.Methods
This retrospective cohort included patients who underwent hepatic resection from 2014 to 2022. Two-year recurrence was analyzed using logistic regression, and recurrence-free survival (RFS) was analyzed using Cox regression. The revised full model contained seven explicitly specified predictors: Ki-67, preoperative TACE/RFA, microvascular invasion (MVI), satellite nodules, tumor diameter, prothrombin time (PT), and preoperative ascites. Missing model covariates were addressed in a 50-dataset multiple-imputation sensitivity analysis. Internal validation used 1,000 bootstrap resamples with the complete seven-predictor model refitted in each resample.Results
Among 215 patients, 93 (43.3%) developed recurrence within 24 months. The complete-case model included 190 patients and 83 events. In adjusted logistic analysis, Ki-67, preoperative TACE/RFA, MVI, satellite nodules, tumor diameter, and PT were associated with recurrence; preoperative ascites was retained but was not statistically significant. In adjusted Cox analysis, Ki-67, MVI, satellite nodules, and PT were associated with shorter 2-year RFS. The nomogram had an apparent AUC of 0.775 and an optimism-corrected AUC of 0.744; the optimism-corrected Brier score and calibration slope were 0.206 and 0.808, respectively. Multiple-imputation estimates were directionally consistent with the complete-case results.Conclusions
In patients with resected HCC ≤5 cm, proliferative activity, microscopic dissemination, tumor burden, and hepatic synthetic function contributed to early-recurrence risk. The internally validated nomogram showed moderate discrimination but remains exploratory and requires independent external validation before clinical use.
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BibTeX
@article{zhang2026clinicopathological,
title = {{Clinicopathological predictors and an internally validated exploratory nomogram for 2-year recurrence after hepatic resection of hepatocellular carcinoma ≤5 cm.}},
author = {Wei Zhang and Yubo Zhang and Qi Wang and Peng Tian and Ruilong Bai and Peng Lei},
journal = {Frontiers in medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1948479},
url = {https://europepmc.org/article/MED/42923099},
note = {CC BY},
}
RIS
TY - JOUR
TI - Clinicopathological predictors and an internally validated exploratory nomogram for 2-year recurrence after hepatic resection of hepatocellular carcinoma ≤5 cm.
AU - Wei Zhang
AU - Yubo Zhang
AU - Qi Wang
AU - Peng Tian
AU - Ruilong Bai
AU - Peng Lei
PY - 2026
DA - 2026/10/08
JO - Frontiers in medicine
DO - 10.3389/fmed.2026.1948479
UR - https://europepmc.org/article/MED/42923099
AB - Background Recurrence remains common after resection of hepatocellular carcinoma (HCC) even when tumor diameter is limited. We evaluated routinely available clinicopathological predictors of recurrence within 2 years after resection of HCC ≤5 cm and developed an exploratory nomogram with bootstrap internal validation.Methods This retrospective cohort included patients who underwent hepatic resection from 2014 to 2022. Two-year recurrence was analyzed using logistic regression, and recurrence-free survival (RFS) was analyzed using Cox regression. The revised full model contained seven explicitly specified predictors: Ki-67, preoperative TACE/RFA, microvascular invasion (MVI), satellite nodules, tumor diameter, prothrombin time (PT), and preoperative ascites. Missing model covariates were addressed in a 50-dataset multiple-imputation sensitivity analysis. Internal validation used 1,000 bootstrap resamples with the complete seven-predictor model refitted in each resample.Results Among 215 patients, 93 (43.3%) developed recurrence within 24 months. The complete-case model included 190 patients and 83 events. In adjusted logistic analysis, Ki-67, preoperative TACE/RFA, MVI, satellite nodules, tumor diameter, and PT were associated with recurrence; preoperative ascites was retained but was not statistically significant. In adjusted Cox analysis, Ki-67, MVI, satellite nodules, and PT were associated with shorter 2-year RFS. The nomogram had an apparent AUC of 0.775 and an optimism-corrected AUC of 0.744; the optimism-corrected Brier score and calibration slope were 0.206 and 0.808, respectively. Multiple-imputation estimates were directionally consistent with the complete-case results.Conclusions In patients with resected HCC ≤5 cm, proliferative activity, microscopic dissemination, tumor burden, and hepatic synthetic function contributed to early-recurrence risk. The internally validated nomogram showed moderate discrimination but remains exploratory and requires independent external validation before clinical use.
SN - 2296-858X
ER -