SR-HCC Score: A Novel Nomogram for Predicting Spontaneous Rupture in Hepatocellular Carcinoma Patients

Siyuan Gao,1, Xiuling Zhang,1, Ting Jia,1 Qiu Jin,1 Xiaodong Yang,1 Ruisi Zhao,2 Jianpeng Gao3,4 1Liver Center, The Third People’s Hospital of Kunming, Kunming, Yunnan, 650041, People’s Republic of China; 2Department of Biomedical Sciences and Biotechnology, Hong Kong Metropolitan University, Hongkong, 999077, People’s Republic of China; 3Cell and Gene Therapy Research Center, Shenzhen Ruipuxun Academy for Stem Cell 4Department of Gastroenterology, Yan’an Hospital Affiliated to Kunming Medical University, Kunming, Yunnan, 650051, People’s Republic of ChinaThese authors contributed equally to this workCorrespondence: Jianpeng Gao, Email gaojianpengkm@163.comPurpose: Hepatocellular carcinoma (HCC) Spontaneous rupture (srHCC) is a life-threatening complication with a high mortality rate; however, no integrated predictive tool exists. This study aimed to develop and validate a novel nomogram (SR-HCC score) for srHCC risk prediction using a combination of clinical, radiological, and laboratory parameters.Methods: This retrospective cohort study included 186 HCC patients from The Third People’s Hospital of Kunming (2010– 2025), randomly split into training (80%) and validation (20%) sets. Covariates included demographic, tumor-related, and laboratory indices. Univariate and multivariate logistic regression analyses were used to identify independent predictors that were integrated into the nomogram. Model performance was evaluated using Receiver Operating Characteristic (ROC) curves (discrimination) and calibration curves.Results: Key independent predictors of srHCC included tumor diameter (3– 5 cm and 5– 10 cm), number of tumors (2– 3), capsular protrusion, Alpha-Fetoprotein (AFP) ≥ 100 ng/mL, moderate ΔALT (0– 200 U/L, inverse association), and ΔAST > 200 U/L. The nomogram achieved excellent discrimination (Area Under the Curve, AUC = 0.9617 in the training set; 0.9630 in the validation set) and good calibration, with predicted probabilities that closely matched the observed outcomes.Conclusion: SR-HCC score is a reliable and user-friendly tool for individualized srHCC risk stratification. This enables clinicians to prioritize preventive interventions and optimize surveillance, especially in resource-limited settings, ultimately improving patient outcomes by preventing catastrophic ruptures.Keywords: hepatocellular carcinoma, spontaneous rupture, nomogram, SR-HCC score, risk prediction