A Prediction of Hepatocellular Carcinoma-Associated Cachexia: The Value of a Nomogram Based on Magnetic Resonance Imaging and Serum Characterisitcs

Abstract

Abstract Background and Objectives: About 50.1% of hepatocellular carcinoma (HCC) patients are present with cachexia. Therefore, it remains urgent regarding an early detection of cachexia in HCC patients. This study reported the predictive value of a nomogram based on the clinical and magnetic resonance imaging (MRI) parameters in diagnosing cachexia in HCC patients. Materials and Methods A retrospective two-center study recruited the pretreatment clinical and MRI data of 489 HCC patients undergoing contrast-enhanced abdominal MRI. The data were divided into three cohorts for training and internal and external validation cohorts. Cancer-associated cachexia was initially diagnosed as weight loss > 5% over 6 months without diet control, or body mass index < 20 kg/m2 and weight loss > 2%. Logistic regression analyses were performed to identify independent variables associated with cachexia in the training cohort used to build the nomogram. Area under receiver operating characteristic curve (AUC) and calibration curve were used to evaluate nomogram performance. Results The independent factors for HCC-associated cachexia included clinical characteristics (serum α-fetoprotein level > 100 ng/mL and serum carbohydrate antigen 19 − 9 level > 37 U/mL) and MRI findings (tumor size > 5 cm, intralesional fat, portal vein tumor thrombus, and intratumoral artery). The nomogram constructed with these variables showed good predictive performance with AUC of 0.83 (training cohort), 0.79 (internal validation cohort), and 0.85 (external validation cohort), and a satisfactory consistency between prediction and observation on the calibration curve in all cohorts. Conclusion The proposed multivariable nomogram suggested good performance in predicting the risk of cachexia in HCC patients.