A Nomogram Prognostic Model for Advanced Hepatocellular Carcinoma Based on the Interaction Between CD8⁺T Cell Counts and Age

Abstract

Objective

CD8⁺T cells are essential components of the adaptive immune system and are crucial in the body’s immune system. This study aimed to investigate how the prognosis of patients with advanced hepatocellular carcinoma (HCC) was affected by their CD8⁺ T cell counts and age and established an effective nomogram model to predict the overall survival (OS).

Methods

A total of 427 patients with advanced HCC from Beijing Ditan Hospital, Capital Medical University, were enrolled in this study and randomly divided into training and validation groups, with 300 and 127 individuals in each group, respectively. Cox regression analysis was used to screen for independent risk factors for advanced HCC, and the interactive relationship between CD8⁺T cells and patient age was examined to establish a nomogram prediction model.

Results

Cox multivariate regression and interaction analyses indicated that tumor number, tumor size, aspartate aminotransferase (AST), C-reactive protein (CRP), relationship of CD8⁺T cell counts and age were independent predictors of 6-month OS in patients with advanced HCC, and the nomogram model was established based on these factors. The area under the receiver operating characteristic curve (AUC) of the nomogram model for predicting the 3-month, 6-month, and 12-month OS rates were 0.821, 0.802, and 0.756, respectively. Moreover, in clinical practice, patients with true-positive survival benefit more than true-positive death, therefore, we selected 25% as the clinical decision threshold probability based on probability density functions (PDFs) and clinical utility curves (CUCs), which can distinguish approximately 92% of patients who died and 37% of patients who survived.

Conclusion

The nomogram model based on CD8⁺T cell counts and age accurately assessed the prognosis of patients with advanced HCC and suggested that high CD8⁺T cell levels are beneficial to the survival of patients with advanced HCC.

Keywords:

• advanced hepatocellular carcinoma
• nomogram
• CD8⁺T cell counts
• age
• overall survival

Abbreviations

HBV, hepatitis B virus; HCV, hepatitis C virus; WBC, white blood cells; ALT, alanine aminotransferase; AST, aspartate aminotransferase; NLR, Neutrophil‐lymphocyte ratio; TBIL, total bilirubin; γ-GGT, γ-glutamyl transferase, LDH, lactate dehydrogenase; ALP, alkaline phosphatase; PTA, prothrombin time activity; INR, international normalized ratio; CRP, C reactive protein; AFP, alpha-fetoprotein; ALB, albumin; SD, standard deviation.

Ethics Approval and Consent to Participate

This study is in accordance with the Declaration of Helsinki and has been approved by the ethical committee of Beijing Ditan Hospital, Capital Medical University. This study was a retrospective research. The ethics committee approved it to be used in this study while ensuring patient privacy, not interfering with the patient’s treatment methods, and not bringing risks to the patient’s physiology.

Acknowledgments

This study was supported by the National Science Foundation of China (No. 82274479, No. 82104781), High-level Public Health Technical Personnel Construction Project (Subject leaders-02-16), Dengfeng Talent Support Program of Beijing Municipal Administration of Hospitals (No. DFL20191803), Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support (No. ZYLX202127), the Special Fund of Capital Health Research and Development (No. 2020-2-2173), Fund of Beijing Ditan Hospital, Capital Medical University (DTYM-202113), Beijing Hospitals Authority Youth Programme (QML20231801).

Disclosure

The authors declare that they have no conflicts of interest in this work.