Nomogram for predicting post-transarterial chemoembolization survival in recurrent patients with hepatitis B virus-associated hepatocellular carcinoma

In the population of patients with hepatitis B virus (HBV)-associated hepatocellular carcinoma (HCC) experiencing postoperative recurrence and undergoing subsequent transarterial chemoembolization (TACE), a comprehensive model for outcome prediction and risk stratification remains lacking. Between 2016 and 2021, a total of 189 eligible patients from two centers were allocated into training, internal validation, and external validation cohorts. Key factors such as extrahepatic metastasis, prior anti HBV treatment status, Child-Pugh classification, and pre-TACE systemic immune-inflammation response index (SIRI) score were utilized to construct a nomogram via multivariate Cox regression analyses and supported by scientific rationale. The nomogram's predictive performance and discriminative capability were evaluated and compared with the Barcelona Clinic Liver Cancer (BCLC) recurrence staging system. The nomogram consistently demonstrated superior performance over the BCLC system across the training (C-index: 0.76 vs. 0.66), internal validation (C-index: 0.76 vs. 0.76), and external validation datasets (C index: 0.73 vs. 0.65). Furthermore, the nomogram effectively stratified patients into low-, medium-, and high-risk categories, each characterized by distinct median post-recurrence survival (PRS) times: 51.2 months (95% CI: 27.7, 60.2), 18.6 months (95% CI: 13.9, 35.0), and 6.0 months (95% CI: 3.8, 8.0), respectively. The nomogram can be used to stratify the risk of HBV-associated HCC that recurs after curative resection and experiences further TACE and predicts individual survival with reliable performance and discrimination.