Development and validation of an individualized prediction calculator of postoperative mortality within 6 months after surgical resection for hepatocellular carcinoma: an international multicenter study
Development and validation of an individualized prediction calculator of postoperative mortality within 6 months after surgical resection for hepatocellular carcinoma: an international multicenter study
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DOI：
10.1007/s12072-021-10140-7
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发表时间：
2021-02
影响因子：
6.6
通讯作者：
L. Liang;B. Quan;Han Wu;Yongkang Diao;Jie-Wei Li;Ting-Hao Chen;Yao-Ming Zhang;Yahao Zhou;Wan-guang Zhang;Hong Wang;M. Serenari;M. Cescon;M. Schwartz;Y. Zeng;Ying-Jian Liang;Hang-Dong Jia;H. Xing;Chao Li;Ming-Da Wang;Wen-Tao Yan;Wanyuan Chen;W. Lau;Cheng-wu Zhang;T. Pawlik;Dong-Sheng Huang;F. Shen;Tian Yang
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文献类型：
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作者：
L. Liang;B. Quan;Han Wu;Yongkang Diao;Jie-Wei Li;Ting-Hao Chen;Yao-Ming Zhang;Yahao Zhou;Wan-guang Zhang;Hong Wang;M. Serenari;M. Cescon;M. Schwartz;Y. Zeng;Ying-Jian Liang;Hang-Dong Jia;H. Xing;Chao Li;Ming-Da Wang;Wen-Tao Yan;Wanyuan Chen;W. Lau;Cheng-wu Zhang;T. Pawlik;Dong-Sheng Huang;F. Shen;Tian Yang
背景基于证据的决策对于优化恶性肿瘤患者手术的益处和减少无效性至关重要。未经治疗的肝细胞癌（HCC）的中位生存期仅为6个月。我们的目标是开发和验证一个个性化的患者特异性工具，术前预测手术的好处，以提供至少6个月的生存率的好处，以下surgence.MethodsUsing国际多中心数据库，从2008年至2017年接受根治性肝切除术的HCC患者进行了鉴定。使用随机分配，三分之二的患者被分配到训练队列，其余三分之一被分配到验证队列。肝癌术后6个月内死亡的独立预测因素被确定，并用于构建具有相应在线计算器的诺模图模型。计算器的预测准确性进行了评估，使用C-指数和校准curves.ResultsIndependent相关因素与6个月内手术死亡包括年龄，Child-Pugh分级，门静脉高压，甲胎蛋白水平，肿瘤破裂，肿瘤大小，肿瘤数量和总血管浸润。包含这些因素的列线图在训练和验证队列中均表现出出色的校准和良好的性能（C指数：0.802和0.798）。诺模图也优于其他四个常用的肝癌分期系统（C指数：0.800与0.542-0.748）。ConclusionsAn易于使用的在线预测计算器能够识别肝癌手术后6个月内死亡风险最高的患者。拟议的在线计算器可能有助于指导手术决策，以避免HCC患者的无效手术。
BackgroundEvidence-based decision-making is critical to optimize the benefits and mitigate futility associated with surgery for patients with malignancies. Untreated hepatocellular carcinoma (HCC) has a median survival of only 6 months. The objective was to develop and validate an individualized patient-specific tool to predict preoperatively the benefit of surgery to provide a survival benefit of at least 6 months following resection.MethodsUsing an international multicenter database, patients who underwent curative-intent liver resection for HCC from 2008 to 2017 were identified. Using random assignment, two-thirds of patients were assigned to a training cohort with the remaining one-third assigned to the validation cohort. Independent predictors of postoperative death within 6 months after surgery for HCC were identified and used to construct a nomogram model with a corresponding online calculator. The predictive accuracy of the calculator was assessed using C-index and calibration curves.ResultsIndependent factors associated with death within 6 months of surgery included age, Child–Pugh grading, portal hypertension, alpha-fetoprotein level, tumor rupture, tumor size, tumor number and gross vascular invasion. A nomogram that incorporated these factors demonstrated excellent calibration and good performance in both the training and validation cohorts (C-indexes: 0.802 and 0.798). The nomogram also performed better than four other commonly-used HCC staging systems (C-indexes: 0.800 vs. 0.542–0.748).ConclusionsAn easy-to-use online prediction calculator was able to identify patients at highest risk of death within 6 months of surgery for HCC. The proposed online calculator may help guide surgical decision-making to avoid futile surgery for patients with HCC.