Development and validation of a nomogram to predict surgical resection after conversion therapy in unresectable hepatocellular carcinoma.

Résumé

OBJECTIVE: This study aimed to explore factors associated with the likelihood of surgical resection after triple-combination conversion therapy in patients with initially unresectable hepatocellular carcinoma (uHCC) and to develop an exploratory predictive model.METHODS: A retrospective analysis was conducted using clinical data from 210 patients with uHCC who underwent triple-combination conversion therapy at Sichuan Cancer Hospital between January 2022 and January 2025. Patients were randomly assigned to a training cohort (n = 147) and a validation cohort (n = 63) in a 7:3 ratio. Least absolute shrinkage and selection operator (LASSO) regression was applied to screen candidate predictors, followed by multivariate logistic regression to identify factors associated with surgical conversion. A nomogram was constructed based on these variables, and its discriminative ability, calibration, and potential clinical utility were internally assessed using receiver operating characteristic (ROC) analysis, calibration plots, the Hosmer-Lemeshow test, and decision curve analysis (DCA).RESULTS: Among the 210 patients, 47 (22.4%) successfully underwent conversion and radical resection. Multivariate logistic regression analysis suggested that lower tumor burden score (TBS; OR = 0.663), lower neutrophil-to-lymphocyte ratio (NLR; OR = 0.572), lower C-reactive protein-to-albumin ratio (CAR; OR = 0.057), and absence of cirrhosis (OR = 0.289) were associated with a higher likelihood of successful surgical conversion (P