Ma Ka Wing, She Wong Hoi, Cheung Tan To, Chan Albert Chi Yan, Dai Wing Chiu, Fung James Yan Yue, Lo Chung Mau, Chok Kenneth Siu Ho
Divisions of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China.
Department of Medicine, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, China.
Surg Today. 2019 Jun;49(6):521-528. doi: 10.1007/s00595-019-1764-x. Epub 2019 Jan 14.
We sought to develop a nomogram for the prediction of tumor recurrence after resection of hepatocellular carcinoma (HCC) within the Milan criteria.
Consecutive HCC patients admitted for hepatectomy between 1994 and 2014 were enrolled in this study. Patients were excluded if they had recurrent HCC or tumors beyond the Milan criteria. Patients were randomized and assigned to the derivation and validation sets in a 1:1 ratio. Independent factors for disease-free survival were identified using the Cox regression model. A nomogram was derived and validated with the receiver-operating characteristic (ROC) and calibration curves.
There were 617 eligible patients included in the analysis. The median age was 59 years, 481 were male, and 87.8% of the patients were hepatitis B virus carriers. The median follow-up was 68.7 months. The 5-year overall survival rate was 73.3% and HCC recurrence was detected in 55% of the patients. In the derivation set, a nomogram was constructed based on the seven independent factors for disease-free survival: age, alpha-fetoprotein, preoperative prothrombin time, magnitude of hepatectomy, postoperative complication, number of tumor nodules, and presence of microvascular invasion. A satisfactory discrimination ability was observed in both the derivation and validation sets (c-stat 0.672 and 0.665, respectively). The calibration plot yielded agreement between the predicted and observed outcomes, using the derived nomogram.
A validated nomogram quantifies the risk of recurrence after hepatectomy for HCC within the Milan criteria, and assists with the planning of individual postoperative surveillance protocols.
我们试图开发一种列线图，用于预测米兰标准内肝细胞癌（HCC）切除术后的肿瘤复发情况。
本研究纳入了1994年至2014年间因肝切除术入院的连续HCC患者。如果患者有复发性HCC或肿瘤超出米兰标准，则将其排除。患者按1:1的比例随机分配到推导集和验证集。使用Cox回归模型确定无病生存的独立因素。通过受试者操作特征（ROC）曲线和校准曲线推导并验证列线图。
分析纳入了617例符合条件的患者。中位年龄为59岁，481例为男性，87.8%的患者为乙型肝炎病毒携带者。中位随访时间为68.7个月。5年总生存率为73.3%，55%的患者检测到HCC复发。在推导集中，基于无病生存的七个独立因素构建了列线图：年龄、甲胎蛋白、术前凝血酶原时间、肝切除量、术后并发症、肿瘤结节数量和微血管侵犯情况。在推导集和验证集中均观察到了良好的区分能力（c统计量分别为0.672和0.665）。使用推导的列线图，校准图显示预测结果与观察结果之间具有一致性。
经过验证的列线图可量化米兰标准内HCC肝切除术后的复发风险，并有助于制定个体化的术后监测方案。
