Defining and predicting early recurrence after liver resection of hepatocellular carcinoma: a multi-institutional study
Defining and predicting early recurrence after liver resection of hepatocellular carcinoma: a multi-institutional study
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肝细胞癌肝切除术后早期复发的定义和预测：一项多机构研究
DOI：
10.1016/j.hpb.2019.09.006
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Yang Tian
中科院分区：
文献类型：
--
作者：
Xing Hao;Zhang Wan-Guang;Cescon Matteo;Liang Lei;Li Chao;Wang Ming-Da;Wu Han;Lau Wan Yee;Zhou Ya-Hao;Gu Wei-Min;Wang Hong;Chen Ting-Hao;Zeng Yong-Yi;Schwartz Myron;Pawlik Timothy M.;Serenari Matteo;Shen Feng;Wu Meng-Chao;Yang Tian
背景肝细胞癌（HCC）切除术后早期复发的定义尚不明确。本研究的目的是确定早期和晚期肝癌复发之间的最佳截止，并制定诺模图的前和术后预测早期recursion.MethodsPatients接受肝癌切除术从一个多机构的中国数据库。采用最小P值法计算最佳临界值，以确定早期复发。术前和术后早期复发的危险因素被确定，并进一步用于诺模图的构建。结果进行外部验证的西方cohol.ResultsAmong 1501例患者确定，539（35.9%）是无复发。区分早期复发（n = 340，35.3%）和晚期复发（n = 622，64.7%）的最佳长度为8个月。多变量logistic回归分析确定了5个术前和8个术后早期复发因素，并进一步纳入术前和术后列线图（C指数：0.785和0.834）。早期复发概率的校准图拟合得很好。诺模图性能保持使用验证数据集（C指数：0.777术前预测和0.842术后预测）。这两个基于网络的列线图已经发表，可以准确预测术前和术后早期复发。这些可能为可切除HCC患者的个体化治疗或随访提供有用的指导。
BackgroundA clear definition of “early recurrence” after hepatocellular carcinoma (HCC) resection is still lacking. This study aimed to determine the optimal cutoff between early and late HCC recurrence, and develop nomograms for pre- and postoperative prediction of early recurrence.MethodsPatients undergoing HCC resection were identified from a multi-institutional Chinese database. MinimumP-value approach was adopted to calculate optimal cut-off to define early recurrence. Pre- and postoperative risk factors for early recurrence were identified and further used for nomogram construction. The results were externally validated by a Western cohort.ResultsAmong 1501 patients identified, 539 (35.9%) were recurrence-free. The optimal length to distinguish between early (n = 340, 35.3%) and late recurrence (n = 622, 64.7%) was 8 months. Multivariable logistic regression analyses identified 5 preoperative and 8 postoperative factors for early recurrence, which were further incorporated into preoperative and postoperative nomograms (C-index: 0.785 and 0.834). The calibration plots for the probability of early recurrence fitted well. The nomogram performance was maintained using the validation dataset (C-index: 0.777 for preoperative prediction and 0.842 for postoperative prediction).ConclusionsAn interval of 8 months was the optimal threshold for defining early HCC recurrence. The two web-based nomograms have been published to allow accurate pre- and postoperative prediction of early recurrence. These may offer useful guidance for individual treatment or follow up for patients with resectable HCC.