肝癌肝切除术后严重并发症和早期复发的术前风险预测模型的建立和验证

IF 3.2 2区医学 Q1 SURGERY

Surgery Pub Date : 2025-06-27 DOI:10.1016/j.surg.2025.109527

Jun Kawashima MD , Yutaka Endo MD, PhD , Mujtaba Khalil MD , Selamawit Woldesenbet PhD , Miho Akabane MD , Andrea Ruzzenente MD, PhD , Francesca Ratti MD , Hugo Marques MD , Sara Oliveira MD , Jorge Balaia MD , François Cauchy MD , Vincent Lam MD , George Poultsides MD , Minoru Kitago MD, PhD , Irinel Popescu MD, PhD , Guillaume Martel MD , Ana Gleisner MD , Thomas J. Hugh MD , Luca Aldrighetti MD, PhD , Itaru Endo MD, PhD , Timothy M. Pawlik MD, PhD, MPH, MTS, MBA, FACS, FSSO, FRACS (Hon)

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引用次数: 0

摘要

我们试图建立并外部验证一个预测肝细胞癌肝切除术后严重并发症和早期复发风险的术前模型。方法使用一个多机构的国际数据库，对2000年至2023年间因肝细胞癌接受治愈性肝切除术的患者进行了识别。使用多变量分析评估术前特征与严重并发症（定义为Clavien-Dindo分级III或以上的并发症）和早期复发（术后6个月内复发）的关系。开发了严重并发症和早期复发的预测模型并进行了外部验证。结果969例患者中，重度并发症97例（10.0%），极早期复发116例（12.0%）。在多变量分析中，美国麻醉医师学会2级和较高的白蛋白-胆红素评分与严重的并发症相关。同时，较高的白蛋白-胆红素评分和较高的肿瘤负荷评分与极早复发相关。非常早期复发的预测模型能够根据患者的复发风险对患者进行分层：低风险（6个月无复发生存率，94.1%），中风险（6个月无复发生存率，86.0%）和高风险（6个月无复发生存率，67.1%）。共有74例患者（7.6%）存在不良风险（严重并发症风险≥30%，极早期复发高风险）。严重并发症(训练：曲线下面积，0.69；外部验证：曲线下面积，0.80)和极早期复发(训练：C-index: 0.65；外部验证：c -指数：0.71)模型是有利的（见在线计算器：https://junkawashima.shinyapps.io/HCC_comp_VER/）.ConclusionAn易于使用的在线计算器相对于短期和长期风险对患者进行分层，确定了严重并发症高风险和非常早期复发的患者亚群，这些患者不太可能从手术切除中获益。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Development and validation of a preoperative risk prediction model for severe complications and very early recurrence after liver resection for hepatocellular carcinoma

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Development and validation of a preoperative risk prediction model for severe complications and very early recurrence after liver resection for hepatocellular carcinoma

Introduction

We sought to develop and externally validate a preoperative model for predicting the risk of severe complications and very early recurrence after liver resection for hepatocellular carcinoma.

Methods

Patients who underwent curative-intent hepatectomy for hepatocellular carcinoma between 2000 and 2023 were identified using a multi-institutional international database. Preoperative characteristics were assessed in relation to severe complications (defined as complications with a Clavien-Dindo classification III or greater) and very early recurrence (recurrence within 6 months after surgery) using multivariable analysis. Predictive models for severe complications and very early recurrence were developed and externally validated.

Results

Among 969 patients, 97 patients (10.0%) experienced severe complications, and 116 patients (12.0%) developed very early recurrence. On multivariable analysis, American Society of Anesthesiologists class >2 and greater albumin-bilirubin score were associated with severe complications. Meanwhile, a greater albumin-bilirubin score and higher tumor burden score were associated with very early recurrence. A predictive model for very early recurrence was able to stratify patients relative to their risk for recurrence: low-risk (6-month recurrence-free survival, 94.1%), medium-risk (6-month recurrence-free survival, 86.0%), and high-risk (6-month recurrence-free survival, 67.1%). A total of 74 patients (7.6%) had an unfavorable risk profile (severe complication risk ≥30% and high-risk for very early recurrence). The discriminative accuracy of the severe complications (training: area under the curve, 0.69; external validation: area under the curve, 0.80) and very early recurrence (training: C-index: 0.65; external validation: C-index: 0.71) models were favorable (see online calculator: https://junkawashima.shinyapps.io/HCC_comp_VER/).

Conclusion

An easy-to-use online calculator stratified patients relative to short- and long-term risks, identifying a subset of patients at a high risk of severe complications and very early recurrence who were unlikely to benefit from surgical resection.

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来源期刊

Surgery 医学-外科

CiteScore

5.40

自引率

5.30%

发文量

687

审稿时长

64 days

期刊介绍： For 66 years, Surgery has published practical, authoritative information about procedures, clinical advances, and major trends shaping general surgery. Each issue features original scientific contributions and clinical reports. Peer-reviewed articles cover topics in oncology, trauma, gastrointestinal, vascular, and transplantation surgery. The journal also publishes papers from the meetings of its sponsoring societies, the Society of University Surgeons, the Central Surgical Association, and the American Association of Endocrine Surgeons.