Clinicopathological predictors and an internally validated exploratory nomogram for 2-year recurrence after hepatic resection of hepatocellular carcinoma ≤5 cm

BackgroundRecurrence remains common after resection of hepatocellular carcinoma (HCC) even when tumor diameter is limited. We evaluated routinely available clinicopathological predictors of recurrence within 2 years after resection of HCC ≤5 cm and developed an exploratory nomogram with bootstrap internal validation.MethodsThis retrospective cohort included patients who underwent hepatic resection from 2014 to 2022. Two-year recurrence was analyzed using logistic regression, and recurrence-free survival (RFS) was analyzed using Cox regression. The revised full model contained seven explicitly specified predictors: Ki-67, preoperative TACE/RFA, microvascular invasion (MVI), satellite nodules, tumor diameter, prothrombin time (PT), and preoperative ascites. Missing model covariates were addressed in a 50-dataset multiple-imputation sensitivity analysis. Internal validation used 1,000 bootstrap resamples with the complete seven-predictor model refitted in each resample.ResultsAmong 215 patients, 93 (43.3%) developed recurrence within 24 months. The complete-case model included 190 patients and 83 events. In adjusted logistic analysis, Ki-67, preoperative TACE/RFA, MVI, satellite nodules, tumor diameter, and PT were associated with recurrence; preoperative ascites was retained but was not statistically significant. In adjusted Cox analysis, Ki-67, MVI, satellite nodules, and PT were associated with shorter 2-year RFS. The nomogram had an apparent AUC of 0.775 and an optimism-corrected AUC of 0.744; the optimism-corrected Brier score and calibration slope were 0.206 and 0.808, respectively. Multiple-imputation estimates were directionally consistent with the complete-case results.ConclusionsIn patients with resected HCC ≤5 cm, proliferative activity, microscopic dissemination, tumor burden, and hepatic synthetic function contributed to early-recurrence risk. The internally validated nomogram showed moderate discrimination but remains exploratory and requires independent external validation before clinical use.