Nomogram predicting outcomes in HCC patients treated with TACE-HAIC, TKIs, and PD-1 inhibitors

BACKGROUND: This study aimed to develop and validate a prognostic nomogram to predict overall survival (OS) in patients with Barcelona Clinic Liver Cancer (BCLC) stage C hepatocellular carcinoma (HCC) undergoing multimodal therapy, combining transarterial chemoembolization, hepatic arterial infusion chemotherapy, tyrosine kinase inhibitors, and programmed death-1 inhibitors. METHODS: A retrospective analysis included 193 patients with BCLC stage C HCC treated at Xuzhou Medical University Affiliated Hospital between February 2021 and February 2024. Patients were randomly divided into a training cohort (n = 135) and a validation cohort (n = 58). Independent prognostic factors were identified via Cox regression analysis. A nomogram was developed and evaluated using the concordance index (C-index), time-dependent receiver operating characteristic curves, calibration plots, and decision curve analysis. Risk stratification was performed using X-tile software. RESULTS: The median OS was 402 days. Multivariate analysis identified ALBI grade (HR [Hazard Ratio] = 10.09-19.63), maximum tumor diameter ≥ 5 cm (HR = 2.69), multiple tumors (HR = 2.59), and vascular invasion (HR = 2.74) as independent predictors of OS. The nomogram demonstrated strong discriminatory performance, with C-indices of 0.788 in the training cohort and 0.805 in the validation cohort. The time-dependent AUCs for 1-year and 1.5-year OS were 0.879 and 0.887 in the training cohort, and 0.923 and 0.832 in the validation cohort, respectively. Calibration curves showed excellent agreement between predicted and observed outcomes. Decision curve analysis supported the clinical utility of the model. Risk stratification based on the nomogram revealed significant survival differences between the low- and high-risk groups (median OS: 566 vs. 454 days; P < 0.001). CONCLUSIONS: This novel nomogram, integrating locoregional and systemic therapies, offers an individualized tool for prognostication in patients with BCLC stage C HCC, potentially guiding therapeutic decision-making and patient counseling.