Lim Chetana, Dejong Cornelius H, Farges Oliver
Department of Surgery, Assistance Publique Hôpitaux de Paris (AP-HP), Henri Mondor Hospital, Faculty of Medicine, University of Paris Est, Creteil, France.
HPB (Oxford). 2015 Mar;17(3):209-21. doi: 10.1111/hpb.12346. Epub 2014 Oct 17.
Liver resection is considered to offer the only hope of cure for patients with liver malignancy. However, there are concerns about its safety, particularly in view of the increasing efficacy of less invasive strategies. No systematic review of prognostic research in liver resections has yet been performed.
A systematic search identified articles published between 1999 and 2012 that performed a risk prediction analysis in patients undergoing liver resection. Studies were included if an outcome occurring within 90 days of surgery was identified, multivariable analysis performed and regression coefficients provided. The main endpoints were the outcomes and predictors chosen by the investigators, their definition, the performance and validity of the models, and the quality of the study as assessed using the QUIPS (quality in prognosis studies) tool.
A total of 91 studies were included. Eleven were prospective, but only two of these were registered. Twenty-eight endpoints were identified. These focused on postoperative morbidity or mortality, but many were redundant or ill defined and other relevant patient-reported outcomes were lacking. Predictors were not standardized, were poorly defined and overlapped. Only nine studies assessed the performance of their models and seven made an internal or temporal validation, but none reported an external validation or impact analysis. The median QUIPS score was 34 out of 50, indicating a high risk for bias.
Prognostic research in liver resection is still at the developmental stage.
肝切除术被认为是肝恶性肿瘤患者唯一的治愈希望。然而，人们对其安全性存在担忧，尤其是考虑到侵入性较小的治疗策略疗效不断提高。目前尚未对肝切除术的预后研究进行系统评价。
通过系统检索，确定了1999年至2012年间发表的对接受肝切除术患者进行风险预测分析的文章。如果确定了手术90天内发生的结局、进行了多变量分析并提供了回归系数，则纳入研究。主要终点是研究者选择的结局和预测因素、它们的定义、模型的性能和有效性，以及使用QUIPS（预后研究质量）工具评估的研究质量。
共纳入91项研究。11项为前瞻性研究，但其中只有2项进行了注册。确定了28个终点。这些终点主要关注术后发病率或死亡率，但许多终点冗余或定义不明确，且缺乏其他相关的患者报告结局。预测因素未标准化，定义不清且相互重叠。只有9项研究评估了其模型的性能，7项进行了内部或时间验证，但均未报告外部验证或影响分析。QUIPS评分中位数为50分中的34分，表明存在高偏倚风险。
肝切除术的预后研究仍处于发展阶段。
