在线风险评分用于预测酪氨酸激酶抑制剂和免疫检查点抑制剂治疗后肝癌转换肝切除术患者早期复发的术前和术后

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso Pub Date : 2025-06-16 DOI:10.1016/j.ejso.2025.110220

Kong-Ying Lin , Hong-Zhi Liu , Jian-Wei Liu , Xiao-Dong Zhu , Yang-Xun Pan , Shun-Li Shen , Wei Zhang , Ren-An Jin , Chuang-Ye Han , Jie Chen , Xiao-Yun Zhang , Bin-Yong Liang , Yao-Dong Zhang , Jian Ma , Nan-Ya Wang , Dong-Xiao Li , Rui Xiong , Zhong-Chao Li , Jing-Dong Li , Zhi-Bo Zhang , Yong-Yi Zeng

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引用次数: 0

摘要

背景：酪氨酸激酶抑制剂（TKIs）和免疫检查点抑制剂（ICIs）的转化治疗为不可切除的肝细胞癌（HCC）提供了治愈性切除的潜力。然而，转换肝切除术后的早期复发（≤2年）仍然是一个主要问题。本研究旨在建立和验证在线术前和术后风险评分，以预测肝转换切除术患者的早期复发。方法分析来自28个学术中心的203例最初不可切除的HCC患者在TKI和ICI治疗后行肝转换切除术。使用Cox比例风险分析确定早期复发的独立预测因素，并使用c指数、时间相关AUC （tdAUC）和校准曲线建立并验证风险评分。结果术前风险评分模型包括中性粒细胞/淋巴细胞比值(NLR)≥1.39、肿瘤多发、无影像学反应、无甲胎蛋白（AFP）反应。术后风险评分模型包括NLR≥1.39、多发肿瘤、无AFP反应、大血管侵袭活跃、病理反应不完全。术前风险评分的c指数为0.699（训练）和0.681（验证），术后风险评分的c指数为0.739（训练）和0.706（验证）。通过tdac和标定曲线验证了两种模型的预测精度。决策树分析将患者分为不同的风险类别，2年复发率有显著差异。所有的风险评分模型都可在线用于临床使用。结论在线术前、术后风险评分为预测肝癌患者转体肝切除术后早期复发提供了有价值的工具，有助于手术决策和术后管理。

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Online risk scores for pre- and postoperative prediction of early recurrence in hepatocellular carcinoma patients undergoing conversion liver resection after tyrosine kinase inhibitors and immune checkpoint inhibitors therapy

Background

Conversion therapy with tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs) offers the potential for curative resection in unresectable hepatocellular carcinoma (HCC). However, early recurrence (≤2 years) after conversion liver resection remains a major concern. This study aimed to develop and validate online preoperative and postoperative risk scores to predict early recurrence in patients undergoing conversion liver resection.

Methods

A total of 203 patients with initially unresectable HCC who underwent conversion liver resection following TKI and ICI therapy across 28 academic centers were analyzed. Independent predictors of early recurrence were identified using Cox proportional hazards analyses, and risk scores were developed and validated using the C-index, time-dependent AUC (tdAUC), and calibration curves.

Results

Preoperative risk score model included the neutrophil-to-lymphocyte ratio (NLR) ≥ 1.39, multiple tumors, absence of radiographic response, and no alpha-fetoprotein (AFP) response. Postoperative risk score model included NLR ≥1.39, multiple tumors, no AFP response, active macrovascular invasion, and incomplete pathological response. The preoperative risk score had a C-index of 0.699 (training) and 0.681 (validation), while the postoperative risk score had a C-index of 0.739 (training) and 0.706 (validation). Both models demonstrated good predictive accuracy through tdAUC and calibration curves. Decision tree analysis stratified patients into distinct risk categories with significant differences in 2-year recurrence rates. All risk score models are available online for clinical use.

Conclusion

Online preoperative and postoperative risk scores provide valuable tools for predicting early recurrence in HCC patients after conversion liver resection, aiding in surgical decision-making and postoperative management.

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来源期刊

Ejso 医学-外科

CiteScore

6.40

自引率

2.60%

发文量

1148

审稿时长

41 days

期刊介绍： JSO - European Journal of Surgical Oncology ("the Journal of Cancer Surgery") is the Official Journal of the European Society of Surgical Oncology and BASO ~ the Association for Cancer Surgery. The EJSO aims to advance surgical oncology research and practice through the publication of original research articles, review articles, editorials, debates and correspondence.