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Objective <p>To develop and validate nomogram models based on preoperative CT-derived extracellular volume fraction (ECV) and volumetry for predicting post-hepatectomy liver failure (PHLF) and overall survival (OS) in hepatocellular carcinoma (HCC) patients.</p> Methods <p>Between January 2010 and June 2020, a total of 265 patients with resectable HCC were retrospectively enrolled and divided into a training cohort (<i>n</i> = 157) and an independent validation cohort (<i>n</i> = 108). CT-derived ECV, spleen volume (SV), liver volume (LV), future liver remnant volume (FLRV), body surface area (BSA) and ratios (SV/LV, FLRV/LV, LV/BSA, SV/BSA) were analyzed. Independent predictors for PHLF and OS were identified to construct nomograms. Model performance was evaluated using the concordance index (C-index), receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA).</p> Results <p>Of 265 patients, 77 (29.0%) developed PHLF. Median follow-up was 63 months (49–66 months), with 1-/3-/5-year OS rates of 95.5%, 83.4%, and 68.7%. The nomogram for PHLF prediction, which integrated ECV (<i>P</i> &lt; 0.001), FLRV/LV (<i>P</i> = 0.002), and SV/BSA (<i>P</i> = 0.014), demonstrated superior discrimination than conventional clinical models in both cohorts. The nomogram for OS prediction, combining ECV (<i>P</i> &lt; 0.001) and AST (<i>P</i> = 0.006), also outperformed conventional clinical models in both cohorts.</p> Conclusions <p>The nomograms contributes to the preoperative prediction of PHLF (combining ECV, FLRV/LV, and SV/BSA) and OS (combining ECV and AST) in patients with resectable HCC.</p>

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Preoperative CT-derived extracellular volume fraction and volumetry can predict the post-hepatectomy liver failure and overall survival of patients with hepatocellular carcinoma after resection

  • 期刊论文

  • 发表日期：

    2026年3月25日

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  • Yali Cai,
  • Jiyang Liu,
  • Xiaoqi Sun,
  • Huaijie Cai,
  • Jieyun Chen

摘要

Objective

To develop and validate nomogram models based on preoperative CT-derived extracellular volume fraction (ECV) and volumetry for predicting post-hepatectomy liver failure (PHLF) and overall survival (OS) in hepatocellular carcinoma (HCC) patients.

Methods

Between January 2010 and June 2020, a total of 265 patients with resectable HCC were retrospectively enrolled and divided into a training cohort (n = 157) and an independent validation cohort (n = 108). CT-derived ECV, spleen volume (SV), liver volume (LV), future liver remnant volume (FLRV), body surface area (BSA) and ratios (SV/LV, FLRV/LV, LV/BSA, SV/BSA) were analyzed. Independent predictors for PHLF and OS were identified to construct nomograms. Model performance was evaluated using the concordance index (C-index), receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA).

Results

Of 265 patients, 77 (29.0%) developed PHLF. Median follow-up was 63 months (49–66 months), with 1-/3-/5-year OS rates of 95.5%, 83.4%, and 68.7%. The nomogram for PHLF prediction, which integrated ECV (P < 0.001), FLRV/LV (P = 0.002), and SV/BSA (P = 0.014), demonstrated superior discrimination than conventional clinical models in both cohorts. The nomogram for OS prediction, combining ECV (P < 0.001) and AST (P = 0.006), also outperformed conventional clinical models in both cohorts.

Conclusions

The nomograms contributes to the preoperative prediction of PHLF (combining ECV, FLRV/LV, and SV/BSA) and OS (combining ECV and AST) in patients with resectable HCC.