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Kongying Lin,1,* Qizhen Huang,2,* Yuting Huo,3,* Jianxing Zeng,1 Zongren Ding,1 Pengfei Guo,4 Zhenwei Chen,4 Yongyi Zeng,1 Jingfeng Liu1,4 1Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, People’s Republic of China; 2Department of Radiation Oncology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, People’s Republic of China; 3Department of Otolaryngology, Fujian Medical Maternity and Child Care Hospital, Fuzhou 350014, People’s Republic of China; 4The Big Data Institute of Southeast Hepatobiliary Health Information, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jingfeng Liu; Yongyi ZengDepartment of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Xihong Road 312, Fuzhou 350025, People’s Republic of ChinaTel/ Fax +86 591 8370 5927Email drjingfeng@126.com; lamp197311@126.comPurpose: To develop and validate a nomogram for individualized prediction of the long-term prognosis of patients with non-B, non-C hepatocellular carcinoma (NBNC-HCC) who underwent hepatectomy.Materials and Methods: Five hundred ninety-four patients who met the criteria were included in the research and randomly categorized into the training or validation cohort. The nomogram was constructed on the basis of the independent risk variables that were acquired via multivariate Cox proportional hazard regression analysis. Several complementary methods included the Harrell c-index, time-dependent areas under the receiver operating characteristic curve (tdAUC), and calibration plot, and the Kaplan–Meier curve with Log rank test were used to test predictive performance of the model. The clinical utility of the model was tested by the decision cure analysis (DCA).Results: Tumor diameter, tumor number, elevated serum gamma-glutamyl transpeptidase (GGT) level, microvascular invasion (MVI), and macrovascular invasion were independent risk factors of prognosis of NBNC-HCC. C-indexes of the nomogram were 0.702 (95% confidence interval [CI], 0.662– 0.741) in the training cohort and 0.700 (95% CI, 0.643– 0.758) in the validation cohort, and median tdAUC values of the nomogram were 0.743 (range, 0.736– 0.775) in the training cohort and 0.751 (range, 0.686– 0.793) in the validation cohort, which were both higher than those in the conventionally used Barcelona Clinic Liver Cancer staging system, American Joint Committee on Cancer, and eighth edition and the model of Zhang et al. The calibration plot depicted a good consistency between prediction of the model and observed outcome. The Kaplan–Meier curve analysis showed that the model was able to separate patients into three distinct risk subgroups. The DCA analysis also demonstrated that the nomogram was clinically useful.Conclusion: We developed and validated a nomogram that was accurate and clinically useful in patients with NBNC-HCC who underwent hepatectomy.Keywords: non-B non-C hepatocellular carcinoma, resection, prognosis, nomogram, survival

Jianxing Zeng,1– 3,* Kongying Lin,4,* Huocheng Liu,1,* Yao Huang,1– 3 Pengfei Guo,4 Yongyi Zeng,1– 3 Jinhua Zeng,1– 3 Jingfeng Liu1– 3 1Department of Hepatic Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, People’s Republic of China; 2The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, People’s Republic of China; 3The Liver Center of Fujian Province, Fujian Medical University, Fuzhou 350025, People’s Republic of China; 4Southeast Big Data Institute of Hepatobiliary Health, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jingfeng Liu Department of Hepatic SurgeryMengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, People’s Republic of ChinaTel/ Fax +86 591 8370 5927Email drjingfeng@126.comBackground: The prognosis of young and older patients with hepatocellular carcinoma (HCC) is controversial. We aim to compare the clinicopathological features and prognosis of young (age ≤ 40 years) versus older patients (aged > 40 years) with hepatitis B virus (HBV)-related HCC after curative resection.Methods: A total of 4504 patients with HBV-related HCC who underwent curative resection were included in this study and divided into young group (n=699) and older group (n=3805). Subgroup analyses were conducted to compare. Independent risk factors were identified by Cox regression analysis.Results: Young patients had better ALBI grade, lower rates of liver cirrhosis, higher rates of elevated serum AFP levels, larger tumor size, higher rates of microvascular invasion and macrovascular invasion, higher rates of Edmondson grade III–IV, lower rates of tumor capsular, more advanced AJCC TNM stages and more advanced BCLC stages than older patients (All p< 0.05). Meanwhile, young patients had a worse overall survival (OS) rate (p=0.0091) and a worse recurrence-free survival (RFS) rate (p=0.045) than older patients. Multivariate analysis revealed that AFP, resection margin, tumor size, tumor capsular, and macrovascular invasion were associated with OS. The independent risk factors associated with RFS were ALB, tumor size, microvascular invasion, and macrovascular invasion.Conclusion: Young patients had better liver function, more aggressive tumor characteristics, and worse prognosis than older patients. A tumor size of ≥ 5 cm and macrovascular invasion were associated with poor OS and RFS in young patients. If tumors could be detected at the early stage by more frequent surveillance, long-term survival can be expected in the young patients.Keywords: hepatocellular carcinoma, young, older, hepatectomy, prognosis