Integrated Clinicopathological Model versus TNM for Predicting Survival in Resected Hepatocellular Carcinoma: A Retrospective Cohort Study

Integrated Clinicopathological Model versus TNM for Predicting Survival in Resected Hepatocellular Carcinoma: A Retrospective Cohort Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Integrated Clinicopathological Model versus TNM for Predicting Survival in Resected Hepatocellular Carcinoma: A Retrospective Cohort Study Gia Anh Pham, Trung Nghia Bui, Tien Cong Bui, Manh Thau Cao, Hong Son Trinh, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9424158/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Objective To explore prognostic factors of postoperative hepatocellular carcinoma (HCC) and compare the prognostic performance of the tumor–node–metastasis (TNM) system with an integrated clinicopathological model. Methods We conducted a cohort study evaluating 249 patients with HCC who underwent radical liver resection between January 2015 and December 2024. Overall survival (OS) was the primary endpoint. Independent prognostic factors were determined using the Cox proportional hazards model. Model performance was assessed using the correlation index (C-index) with bootstrap internal validation. Time-dependent receiver operating characteristic (ROC) curves, decision curve analysis (DCA), and calibration plots were used to assess discrimination, clinical utility, and agreement between predicted and observed outcomes. Results In multivariable analysis, TNM stage, microvascular invasion (MVI), resection margin status, and albumin–bilirubin (ALBI) grade were independent predictors of OS. For recurrence-free survival (RFS), independent predictors included hepatitis status, ALBI grade, TNM stage, and MVI. The integrated model demonstrated improved discrimination compared with TNM alone, with a higher optimism-corrected C-index (0.676 vs. 0.647). Time-dependent ROC analysis showed significantly higher AUC values for the integrated model at 1 year (0.725 vs. 0.669, p=0.046), 3 years (0.703 vs. 0.657, p=0.024), and 5 years (0.684 vs. 0.649, p=0.031). DCA indicated greater net benefit across clinically relevant thresholds, and calibration plots showed good agreement between predicted and observed survival probabilities. Conclusion An integrated clinicopathological model incorporating TNM stage, MVI, ALBI grade, and resection margin status improves prognostic performance compared with TNM alone in patients undergoing curative resection for HCC. This model may support more accurate postoperative risk stratification. Hepatocellular carcinoma hepatectomy TNM staging microvascular invasion ALBI grade prognosis Full Text Additional Declarations No competing interests reported. Supplementary Files Supplementary.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 28 Apr, 2026 Reviewers agreed at journal 28 Apr, 2026 Reviews received at journal 28 Apr, 2026 Reviewers agreed at journal 28 Apr, 2026 Reviewers invited by journal 27 Apr, 2026 Submission checks completed at journal 27 Apr, 2026 First submitted to journal 24 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9424158","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":631480820,"identity":"08e28a4d-0357-42a9-9ca4-2b0556da6b2b","order_by":0,"name":"Gia Anh Pham","email":"","orcid":"","institution":"Department of Oncology and Radiotherapy, Viet Duc University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Gia","middleName":"Anh","lastName":"Pham","suffix":""},{"id":631480825,"identity":"beb1a8d3-3b61-4112-9cd2-c7af8a42904e","order_by":1,"name":"Trung Nghia 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Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Hepatocellular carcinoma, hepatectomy, TNM staging, microvascular invasion, ALBI grade, prognosis","lastPublishedDoi":"10.21203/rs.3.rs-9424158/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9424158/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo explore prognostic factors of postoperative hepatocellular carcinoma (HCC) and compare the prognostic performance of the tumor–node–metastasis (TNM) system with an integrated clinicopathological model.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe conducted a cohort study evaluating 249 patients with HCC who underwent radical liver resection between January 2015 and December 2024. Overall survival (OS) was the primary endpoint. Independent prognostic factors were determined using the Cox proportional hazards model. Model performance was assessed using the correlation index (C-index) with bootstrap internal validation. Time-dependent receiver operating characteristic (ROC) curves, decision curve analysis (DCA), and calibration plots were used to assess discrimination, clinical utility, and agreement between predicted and observed outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn multivariable analysis, TNM stage, microvascular invasion (MVI), resection margin status, and albumin–bilirubin (ALBI) grade were independent predictors of OS. For recurrence-free survival (RFS), independent predictors included hepatitis status, ALBI grade, TNM stage, and MVI. The integrated model demonstrated improved discrimination compared with TNM alone, with a higher optimism-corrected C-index (0.676 vs. 0.647). 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