Abstract: Objective To investigate the risk factors affecting the prognosis of patients with China liver cancer staging (CNLC)Ⅲhepatocellular carcinoma (HCC) who received intensity⁃modulated radiotherapy (IMRT), and a prediction nomogram model was established. Methods The clinicopathologic data of CNLC stageⅢ HCC patients who received IMRT treatment in the Guangxi Medical University Cancer Hospital from January 2012 to March 2021 were collected and analyzed retrospectively. Univariable and multivariatble Cox regression models were used to analyze the independent factors affecting the prognosis of patients. A nomogram was constructed to predict 1⁃year, 2⁃year, and 3⁃year overall survival (OS) rates, and the areas under the curve (AUC) of the receiver operating characteristic (ROC) and calibration curves were used to evaluate the efficacy of the model. The patients were divided into high risk group and low risk group, according to the median risk score of Cox model. The survival curves were plotted by using the Kaplan⁃Meier method, and the survival difference between the two groups was analyzed by log⁃rank. Results A total of 250 HCC patients were included in this study. The results of multivariable Cox regression analysis suggested that tumor number, alpha⁃fetoprotein (AFP), alkaline phosphatase (ALP), and blood platelet (PLT) were the independent prognostic factors of IMRT in HCC patients with CNLC stageⅢ (all P<0.05). The AUC of ROC for the prognosis nomogram predicting the OS of patients at 1⁃year, 2⁃year and 3⁃year were 0.680 (95%CI: 0.613-0.748), 0.717 (95%CI: 0.638-0.796) and 0.783 (95%CI:0.696-0.871), respectively. The calibration curves showed good consistency between the predicted rate and the actual rate. Log⁃rank showed that the OS of the low risk group was significantly better than that of the high risk group (P<0.001). Conclusions Tumor number, AFP, ALP and PLT are independent risk factors affecting the prognosis of CNLC stageⅢHCC patients treated with IMRT. The nomogram model established based on the above indexes may help clinicians to make a more accurate prognosis assessment for patients and guide the clinical individualized treatment.

Key words: Hepatocellular carcinoma, China liver cancer staging, Intensity?modulated radiotherapy, Prognosis, Nomogram