Journal of hepatocellular carcinoma · 2026
Construction of a Nomogram Integrating Magnetic Resonance Imaging Features and Ephrin-A3 Expression to Predict Postoperative Overall Survival in Hepatocellular Carcinoma.
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Zhang Yanyan, Feng Lijuan, Chen Qianjuan, Tan Siyuan, Huang Wanyun, Long Liling
Аннотация
PURPOSE: Elevated EFNA3 mRNA is associated with poor prognosis in hepatocellular carcinoma (HCC). This study aimed to evaluate the prognostic value of Ephrin-A3 immunohistochemical expression and construct a nomogram combining MRI features and Ephrin-A3 expression for postoperative OS prediction in HCC.
PATIENTS AND METHODS: We conducted a retrospective analysis of 111 HCC patients, from whom MRI data were collected, and Ephrin-A3 immunohistochemistry was performed. Using an optimal cut-off value of averaged optical density (AOD) derived from Ephrin-A3 staining to predict OS, patients were categorized into high and low expression groups. The cohort was randomly split into training (70%) and validation (30%) sets. Univariate and multivariate Cox regression analyses identified independent OS predictors, and a nomogram was constructed to predict post-surgical OS. We assessed the model's performance through receiver operating characteristic (ROC) curves, area under the curve (AUC) measurements, Kaplan-Meier survival curves, calibration curves, and decision curve analysis (DCA) in both datasets.
RESULTS: Ephrin-A3 expression, tumor margin, nonrim arterial phase hyperenhancement, and extrahepatic metastasis were independent predictors of OS. The nomogram had concordance indexes of 0.76 and 0.72 in the training and validation sets, respectively. Time‑dependent ROC analysis showed AUCs of 0.790 and 0.776 at 36 and 60 months in the training set, and 0.737 and 0.770 in the validation set; the 12‑month AUC was not estimable due to zero events in the validation set. Kaplan-Meier curves showed significantly prolonged OS in the low-risk group across both datasets. Calibration curves showed good agreement between predicted and actual survival rates, and DCA supported the model's clinical utility.
CONCLUSION: Ephrin-A3 serves as an independent prognostic factor for OS in HCC patients after surgery, and the constructed nomogram exhibits favorable predictive performance for postoperative survival.
PATIENTS AND METHODS: We conducted a retrospective analysis of 111 HCC patients, from whom MRI data were collected, and Ephrin-A3 immunohistochemistry was performed. Using an optimal cut-off value of averaged optical density (AOD) derived from Ephrin-A3 staining to predict OS, patients were categorized into high and low expression groups. The cohort was randomly split into training (70%) and validation (30%) sets. Univariate and multivariate Cox regression analyses identified independent OS predictors, and a nomogram was constructed to predict post-surgical OS. We assessed the model's performance through receiver operating characteristic (ROC) curves, area under the curve (AUC) measurements, Kaplan-Meier survival curves, calibration curves, and decision curve analysis (DCA) in both datasets.
RESULTS: Ephrin-A3 expression, tumor margin, nonrim arterial phase hyperenhancement, and extrahepatic metastasis were independent predictors of OS. The nomogram had concordance indexes of 0.76 and 0.72 in the training and validation sets, respectively. Time‑dependent ROC analysis showed AUCs of 0.790 and 0.776 at 36 and 60 months in the training set, and 0.737 and 0.770 in the validation set; the 12‑month AUC was not estimable due to zero events in the validation set. Kaplan-Meier curves showed significantly prolonged OS in the low-risk group across both datasets. Calibration curves showed good agreement between predicted and actual survival rates, and DCA supported the model's clinical utility.
CONCLUSION: Ephrin-A3 serves as an independent prognostic factor for OS in HCC patients after surgery, and the constructed nomogram exhibits favorable predictive performance for postoperative survival.