Development and Validation of a Nomogram to Preoperatively Estimate Post-hepatectomy Liver Dysfunction Risk and Long-term Survival in Patients With Hepatocellular Carcinoma
Development and Validation of a Nomogram to Preoperatively Estimate Post-hepatectomy Liver Dysfunction Risk and Long-term Survival in Patients With Hepatocellular Carcinoma
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DOI：
10.1097/sla.0000000000003803
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发表时间：
2021-12-01
影响因子：
9
通讯作者：
Li, Le-Qun
中科院分区：
文献类型：
--
作者：
Wang, Yan-Yan;Xiang, Bang-De;Li, Le-Qun
目的：建立一个列线图来估计SPLD（国际肝脏外科研究组定义的B或C级）的风险和肝切除术前HCC患者的长期生存率。背景：SPLD是肝切除术后死亡的主要原因。将HCC患者转诊进行肝切除术的决定主要基于生存获益和SPLD风险。方法：收集2071例因肝癌行肝切除术的患者，随机分为开发队列（n = 1036）和内部验证队列（n = 1035）。来自另一个中心的590名患者被招募为外部验证队列。基于多变量Logistic回归分析中确定的SPLD的独立术前预测因素，开发了一个列线图：在开发，内部和外部验证队列中的SPLD发生率分别为10.1%，9.5%和8.6%。多变量分析确定总胆红素、白蛋白、γ-谷氨酰转肽酶、凝血酶原时间、有临床意义的门脉高压和大切除术为SPLD的独立预测因素。列线图显示出良好的一致性统计，分别为0.883，0.851。和0.856预测SPLD。其在SPLD中的预测性能。90-日死亡率和总生存期（OS）优于Child-Pugh、终末期肝病模型、白蛋白-胆红素和欧洲肝脏研究协会推荐的算法。诺模图评分为137，患者被分为SPLD的低风险和高风险。结论：诺模图在预测SPLD和OS方面具有良好的性能，可帮助外科医生选择合适的肝癌患者进行肝切除术。
Objective: To develop a nomogram to estimate the risk of SPLD (International Study Group of Liver Surgery definition grade B or C) and long-term survival in patients with HCC before hepatectomy.Background: SPLD is the leading cause of post-hepatectomy mortality. The decision to refer an HCC patient for hepatectomy is mainly based on the survival benefit and SPLD risk. Prediction of SPLD risk before hepatectomy is of great significance.Methods: A total of 2071 consecutive patients undergoing hepatectomy for HCC were recruited and randomly divided into the development cohort (n = 1036) and internal validation cohort (n = 1035). Five hundred ninety patients from another center were enrolled as the external validation cohort. A nomogram was developed based on independent preoperative predictors of SPLD determined in multivariable logistic regression analysis.Results: The SPLD incidences in the development, internal, and external validation cohorts were 10.1%, 9.5%, and 8.6%, respectively. Multivariable analysis identified total bilirubin, albumin, gamma-glutamyl transpeptidase, prothrombin time, clinically significant portal hypertension, and major resection as independent predictors for SPLD. Incorporating these variables, the nomogram showed good concordance statistics of 0.883, 0.851. and 0.856, respectively in predicting SPLD in the 3 cohorts. Its predictive performance in SPLD. 90-day mortality, and overall survival (OS) outperformed Child-Pugh, model for end-stage liver disease, albumin-bilirubin, and European Association for the Study of the Liver recommended algorithm. With a nomogram score of 137, patients were stratified into low and high risk of SPLD. High-risk patients also had decreased OS.Conclusions: The nomogram showed good performance in predicting both SPLD and OS. It could help surgeons select suitable HCC patients for hepatectomy.