Construction and external validation of a prognostic model for survival in hepatocellular carcinoma patients undergoing transarterial chemoembolization: a multicenter retrospective cohort study.

[BACKGROUND] Transarterial chemoembolization (TACE) is a primary treatment for hepatocellular carcinoma (HCC). Despite its benefits, not all patients experience prolonged survival. Hence, this study aimed to develop a prognostic model using data from HCC patients who underwent TACE.

[METHODS] This study collected patients with hepatocellular carcinoma who received TACE treatment in the Second Hospital of Dalian Medical University from September 2014 to September 2024 and randomly divided them into the training set and the validation set in a 7:3 ratio. Meanwhile, the data of patients who received TACE treatment at Zhongshan Hospital Affiliated to Dalian University from September 2021 to September 2024 were collected for external validation. Univariable and multivariable Cox analyses in the training cohort identified independent risk factors. Based on these factors, two predictive models were established via Cox regression and random survival forest (RSF). The predictive accuracy of models was appraised using the concordance index (C-index) and the area under the receiver operating characteristic curve (AUC). The calibration of models was assessed via calibration curves.

[RESULTS] This study collected clinical data from 815 HCC patients receiving TACE. Independent risk factors included tumor size, TNM stage, serum alpha-fetoprotein, TACE therapy count, and post-treatment direct bilirubin, lactate dehydrogenase, and gamma-glutamyl transferase levels. In the RSF model, AUCs for predicting 1-, 3-, and 5-year OS 0.88 (95% CI: 0.81-0.94), 0.80 (95% CI: 0.74-0.86), and 0.75 (95% CI: 0.67-0.81) in the internal validation cohort, and 0.87(95%CI:0.76,0.98), 0.91(95%CI:0.85,0.97) and 0.89(95%CI:0.82,0.96) in the external validation cohort. The Cox regression model yielded AUCs for OS at 1, 3, and 5 years of 0.92 (95% CI: 0.87-0.96), 0.83 (95% CI: 0.76-0.89), and 0.81 (95% CI: 0.74-0.88) in the internal validation cohort, and 0.86(95%CI:0.75,0.97), 0.89(95%CI:0.82,0.96)and 0.90(95%CI:0.81,0.99) in the external validation cohort. Given its superior AUC and C-index, a more interpretable survival nomogram was built using the Cox model.

[CONCLUSIONS] The prognostic nomogram, constructed based on routine, interpretable clinical features in this study, may help estimate the risk of death in TACE-treated HCC patients. This tool may provide a crucial reference for decision-making in follow-up treatment and rehabilitation.

[TRIAL REGISTRATION] Not applicable.