Predicting the prognosis of hepatocellular carcinoma after curative resection using a nomogram based on the ratio of prealbumin to platelet distribution width.

[BACKGROUND] Primary liver cancer (PLC) is one of the most common malignant tumors worldwide, with its incidence continuing to rise in recent years. As the main pathological subtype of PLC, hepatocellular carcinoma (HCC) has become a major disease burden threatening global public health. For HCC patients receiving treatment, accurate prognostic stratification is of crucial significance for improving patients' long-term survival. In view of this, this study was designed to explore the predictive value of the ratio of the preoperative prealbumin to the platelet distribution width (PDW), namely, the PPDWR, for the prognosis of HCC following radical resection. Additionally, a nomogram was constructed for survival prediction.

[METHODS] A retrospective analysis was carried out on the data of 205 patients who underwent radical resection for HCC at The Affiliated Hospital of Southwest Medical University between January 2016 and August 2021. These patients were randomly assigned to a training set or a validation set. The optimal cutoff value of the PPDWR was determined by the receiver operating characteristic (ROC) curve of overall survival (OS) in the training set of patients, after which patients were grouped accordingly. The associations between PPDWR and clinical characteristics, as well as its impact on survival, were analyzed. Prognosis-related variables were screened via least absolute shrinkage and selection operator (LASSO)-Cox regression and univariate and multivariate Cox regression. Nomograms for OS and recurrence-free survival (RFS) were subsequently constructed and validated. Finally, the time-dependent ROC curve, concordance index and decision curve analysis were used for survival prediction evaluation. P<0.05 indicated a statistically significant difference.

[RESULTS] The optimal cutoff value of the PPDWR was 14.514 which was correlated with multiple clinical indices. The sensitivity and specificity of this cutoff value were 88.5% and 45.1%, respectively. The OS and RFS of patients in the high-PPDWR subgroup were significantly superior to those in the low-PPDWR subgroup. A low PPDWR level, a high alpha-fetoprotein (AFP) level, were independent risk factors for OS. For RFS, the independent risk factors included a low PPDWR, China Liver Cancer Staging (CNLC) stage III. The constructed nomograms demonstrated good predictive accuracy in both the training set and the validation set.

[CONCLUSIONS] A low preoperative PPDWR is an independent risk factor for poor postoperative prognosis in HCC patients. The nomogram constructed on the basis of the PPDWR can effectively predict the postoperative OS and RFS of patients, thus offering a reference for clinical treatment decision-making.