Construction of a nomogram integrating magnetic resonance imaging features and Ephrin-A3 expression to predict postoperative overall survival in hepatocellular carcinoma

This study aimed to explore the relationship between Ephrin-A3 expression and postoperative overall survival (OS) in hepatocellular carcinoma (HCC) patients and to develop a prognostic nomogram integrating clinical, pathological, MRI features, and Ephrin-A3 expression. We conducted a retrospective analysis of 111 HCC patients, from whom clinical, pathological, and MRI data were collected, and Ephrin-A3 immunohistochemistry was performed. Using an optimal cut-off value of averaged optical density (AOD) derived from Ephrin-A3 staining to predict OS, patients were categorized into high and low expression groups. The cohort was randomly split into training (70%) and validation (30%) sets. Univariate and multivariate Cox regression analyses identified Ephrin-A3 expression, tumor margin, nonrim arterial phase hyperenhancement, and extrahepatic metastasis as independent predictors of OS. A nomogram was subsequently developed to predict postoperative OS. The model demonstrated concordance indexes of 0.76 and 0.72 in the training and validation sets, respectively. The area under the curve (AUC) values for predicting 12-, 36-, and 60-month OS were 0.790, 0.790, and 0.776 in the training set, and 0.970, 0.737, and 0.770 in the validation set. Kaplan–Meier survival analysis confirmed significantly longer OS in the low-risk group in both datasets. Calibration curves indicated strong agreement between predicted and observed survival probabilities, and decision curve analysis (DCA) confirmed the clinical utility of the model. In conclusion, Ephrin-A3 serves as an independent prognostic factor for OS in HCC patients after surgery, and the constructed nomogram exhibits favorable predictive performance for postoperative survival.