Miho Akabane, Jun Kawashima, Selamawit Woldesenbet, Razeen Thammachack, François Cauchy, Federico Aucejo, Irinel Popescu, Minoru Kitago, Guillaume Martel, Francesca Ratti, Luca Aldrighetti, George A Poultsides, Yuki Imaoka, Andrea Ruzzenente, Itaru Endo, Ana Gleisner, Hugo P Marques, Vincent Lam, Tom Hugh, Nazim Bhimani, Feng Shen, Timothy M Pawlik
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SBS was calculated as SBS<sup>2</sup>=(operative time)<sup>2</sup>+(aBL)<sup>2</sup>. Outcomes were any and severe complications (Clavien-Dindo ≥ III). ROC curves and AUCs evaluated performance. A 3:1 training/testing split was used for model development, incorporating SBS plus clinical variables.</p><p><strong>Results: </strong>Among 801 patients, complications occurred in 39.1 %, and severe complications in 11.0 %. On multivariable analysis, operative time (HR:1.231; 95%CI:1.113-1.365; p < 0.001) and aBL (HR:1.021; 95%CI:1.002-1.041; p = 0.036) were independent predictors of any complications. SBS(median:6.07 [IQR:4.08-10.07]) outperformed its components (AUC:0.71vs0.67 for operative time and 0.69 for aBL). Stratified SBS groups demonstrated a dose-dependent increase in complications (p < 0.001). The SBS-based model achieved AUCs of 0.73 (training) and 0.76 (testing), outperforming existing models. 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引用次数: 0
摘要
背景：没有一个经过验证的模型包含肝细胞癌（HCC）切除术并发症风险的手术参数。我们评估了一种新的手术负担评分（SBS），通过毕达哥拉公式整合调整失血量（aBL; mL/kg）和手术时间（小时），并开发了一种基于SBS的模型来预测并发症。方法：从国际数据库中确定2000-2023年接受HCC治疗意图肝切除术的患者。SBS计算为SBS2=（手术时间）2+(aBL)2。结果为任何和严重并发症（Clavien-Dindo≥III）。ROC曲线和auc评估性能。模型开发采用3:1的训练/测试分割，包括SBS和临床变量。结果：801例患者中，并发症发生率为39.1%，严重并发症发生率为11.0%。在多变量分析中，手术时间（HR:1.231; 95%CI:1.113 ~ 1.365; p < 0.001）和aBL （HR:1.021; 95%CI:1.002 ~ 1.041; p = 0.036）是并发症的独立预测因子。SBS（中位数：6.07 [IQR:4.08-10.07]）优于其组成部分（AUC:0.71vs0.67手术时间和0.69 aBL）。分层SBS组并发症呈剂量依赖性增加（p < 0.001）。基于sbs的模型实现了0.73（训练）和0.76（测试）的auc，优于现有模型。可以使用在线计算器（https://makbn.shinyapps.io/SBS_shiny/）。结论：SBS是一种以毕达哥拉斯为基础，结合手术时间和aBL的指标，能准确预测并发症。基于sbs的模型为风险分层提供了强大的预测效用。
The surgical burden score: a novel continuous metric to predict postoperative complications after hepatectomy for hepatocellular carcinoma.
Background: No validated model incorporates surgical parameters for complication risk in hepatocellular carcinoma (HCC) resection. We evaluated a novel Surgical Burden Score (SBS), integrating adjusted blood loss (aBL; mL/kg) and operative time (hours) via a Pythagorean formula, and developed an SBS-based model to predict complications.
Methods: Patients undergoing curative-intent hepatectomy for HCC(2000-2023) were identified from an international database. SBS was calculated as SBS2=(operative time)2+(aBL)2. Outcomes were any and severe complications (Clavien-Dindo ≥ III). ROC curves and AUCs evaluated performance. A 3:1 training/testing split was used for model development, incorporating SBS plus clinical variables.
Results: Among 801 patients, complications occurred in 39.1 %, and severe complications in 11.0 %. On multivariable analysis, operative time (HR:1.231; 95%CI:1.113-1.365; p < 0.001) and aBL (HR:1.021; 95%CI:1.002-1.041; p = 0.036) were independent predictors of any complications. SBS(median:6.07 [IQR:4.08-10.07]) outperformed its components (AUC:0.71vs0.67 for operative time and 0.69 for aBL). Stratified SBS groups demonstrated a dose-dependent increase in complications (p < 0.001). The SBS-based model achieved AUCs of 0.73 (training) and 0.76 (testing), outperforming existing models. An online calculator is available (https://makbn.shinyapps.io/SBS_shiny/).
Conclusions: SBS, a Pythagorean-based metric combining operative time and aBL, accurately predicts complications. The SBS-based model offers strong predictive utility for risk stratification.
期刊介绍：
HPB is an international forum for clinical, scientific and educational communication.
Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice.
Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice.
HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields.
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HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).
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