Determinants of Fear of Cancer Recurrence and Development of a Nomogram-Based Risk Prediction Model in Patients with Primary Liver Cancer: A Single-Center Cross-Sectional Study

Background: Fear of cancer recurrence (FCR) is a prevalent and clinically significant psychological burden among cancer survivors. Its determinants and risk stratification in patients with primary liver cancer remain insufficiently characterized. Objective: To assess FCR prevalence, identify independently associated factors, and develop a nomogram-based risk prediction model in patients with primary liver cancer. Materials and Methods: This single-center, cross-sectional study enrolled 175 consecutively recruited patients with primary liver cancer. FCR was measured using the Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF; cut-off ≥ 27). Sociodemographic, clinical, and psychosocial variables were collected via standardized instruments. Candidate variables significant in univariate analysis were entered into multivariable logistic regression; only variables retaining independent significance were incorporated into the nomogram. Internal validation was performed using bootstrap resampling (1000 iterations). Model performance was assessed by discrimination (C-index), calibration (Hosmer-Lemeshow test), and clinical utility (decision curve analysis). Results: High FCR (FCRI-SF ≥ 27) was identified in 96 of 175 patients (54.86%). Female sex and advanced tumor stage were independently associated with higher concurrent FCR likelihood. Moderate household income, absence of hepatitis B virus (HBV) infection, longer disease duration, and higher social support scores were independently associated with lower concurrent FCR likelihood. The model demonstrated acceptable discrimination (C-index = 0.782; bootstrap-corrected C-index = 0.769) and good calibration (Hosmer-Lemeshow P = 0.782). Decision curve analysis indicated net clinical benefit across a clinically relevant threshold probability range. Conclusion: FCR is highly prevalent in patients with primary liver cancer and is shaped by both clinical and psychosocial factors. The nomogram developed in this study demonstrates promising internal performance and may support individualized FCR risk stratification following external validation in independent, multi-center cohorts.