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)
{"title":"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","authors":"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)","doi":"10.1016/j.surg.2025.109527","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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: <span><span>https://junkawashima.shinyapps.io/HCC_comp_VER/</span><svg><path></path></svg></span>).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"185 ","pages":"Article 109527"},"PeriodicalIF":3.2000,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Development and validation of a preoperative risk prediction model for severe complications and very early recurrence after liver resection for hepatocellular carcinoma\",\"authors\":\"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)\",\"doi\":\"10.1016/j.surg.2025.109527\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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: <span><span>https://junkawashima.shinyapps.io/HCC_comp_VER/</span><svg><path></path></svg></span>).</div></div><div><h3>Conclusion</h3><div>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.</div></div>\",\"PeriodicalId\":22152,\"journal\":{\"name\":\"Surgery\",\"volume\":\"185 \",\"pages\":\"Article 109527\"},\"PeriodicalIF\":3.2000,\"publicationDate\":\"2025-06-27\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0039606025003794\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Surgery","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0039606025003794","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"SURGERY","Score":null,"Total":0}
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.
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.