Patient selection

We performed a retrospective cohort study on 558 AFP-negative (< 8.78 ng/mL) HCC patients following non-surgical therapy using data from the Beijing Ditan Hospital between January 2008 and December 2016. The HCC diagnosis data included biopsy, radiology. First, we selected patients based on hepatic angiography, pathology in combination with ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI). Next, we only included patients with complete clinical data. Our exclusion criteria included: (1) other viral infections such as human immunodeficiency virus (HIV); (2) metastatic liver cancer; (3) pregnant women; (4) incomplete data; (5) following surgical therapy; and (6) patients with liver transplantation and survival time < 15 days. The primary cohort of our study included 410 clinically diagnosed patients with AFP-NHCC, retrospectively studied via an information system between January 2008 and December 2014. The patients were followed for 5 years (death follow-up stopped) and first hospitalization records were kept. One hundred forty eight patients with AFP-NHCC between January 2015 and December 2016 as an independent validation cohort. The patients were followed for 3 years (death follow-up stopped) and first hospitalization records were kept. It is recommended that all HCC patients undergo regular follow-up visits according to clinical guidelines after completion of hospital admission, usually every 3 months for the first 2 years and once a year for the next 3 to 5 years. Patients who did not come to our hospital on time for review were given treatment information and living conditions by telephone follow-up (telephone follow-up by our clinicians), the last follow-up occurred in December 2019. The outcome of our study was overall survival (OS), defined as the time from the diagnosis of HCC to the last follow-up or death. The study was approved by the ethics committee of Beijing Ditan Hospital, Capital Medical University and was conducted in accordance with the standards of the Declaration of Helsinki.