Nucleolin as a Potent Biomarker for Predicting Tumor Recurrence among Patients with Hepatocellular Carcinoma after Transplantation

Background and Aims: Tumor recurrence poses a significant challenge post-liver transplantation (LT) for hepatocellular carcinoma (HCC), necessitating the development of more precise predictive tools. In this study we aimed to investigate nucleolin as a biomarker for predicting HCC recurrence after LT. Methods: A cohort of 241 HCC patients undergoing LT was enrolled from three medical facilities spanning January 1, 2015, to December 31, 2017. Utilizing tissue microarrays, we assessed the predictive potential of nucleolin. Survival analyses, including Kaplan-Meier and log-rank tests, were employed to scrutinize overall survival and recurrence-free survival. Based on univariate and multivariate Cox regression analyses of preoperative parameters, nomogram and risk score were designed to predict HCC recurrence and determine the effectiveness of the model. Results: The expression of nucleolin in HCC nucleus was increased. High nucleolin expression in tumor tissues correlated with poor overall survival and recurrence-free survival (5-year overall survival ratios: 34% vs. 64.8%, 5-year recurrence-free survival ratios: 36.1% vs.67.9%, all p<0.001). Multivariate Cox regression analysis identified nucleolin expression score, Hangzhou criteria, HBsAg, tumor differentiation and alpha-fetoprotein level as independent risk factors for tumor recurrence in HCC patients post- LT. A new nomogram is established based on the above risk factors with effective prediction efficiency (area under time-dependent receiver operating characteristic =0.742, concordance-index =0.7742). Conclusions: Nucleolin can be combined with a nomogram as an effective tool to predict recurrence in HCC patients following LT.