Guangdong Provincial Clinical and Engineering Center of Digital Medicine, The First Department of Hepatobiliary Surgery Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China.
World J Surg. 2020 Jun;44(6):1945-1953. doi: 10.1007/s00268-020-05401-9.
With the improvement in diagnostic imaging, perioperative care and surgical technique, the indications and complexity of liver resections have developed. However, the surgical indications remain controversial especially for some complex or advanced hepatocellular carcinomas. This study was designed to evaluate the concordance between hepatectomy recommendations proposed by Watson for Oncology, a cognitive technology providing decision support, and those determined by surgeons in our center for patients with hepatocellular carcinoma.
We retrospectively reviewed 243 patients with hepatocellular carcinoma who were recommended for surgical treatment and received hepatectomy between 2008 and 2016 at the Zhujiang Hospital of Southern Medical University. Watson for Oncology classified the treatment options into three categories: recommended, for consideration and not recommended. Treatment recommendations were considered concordant if the hepatectomy recommendations were designated "recommended" or "for consideration" by Watson for Oncology. The factors potentially affecting concordance rate were also analyzed in our study.
The hepatectomy recommendations of 174 patients were concordant. There were significant differences in the coincidence rate between concordant group and discordant group considering tumor numbers (P = 0.006), extension of hepatectomy (P = 0.009) and BCLC staging system (P < 0.001). Lower degrees of concordance were observed in patients with multiple tumors, major hepatectomy and portal hypertension by using logistic regression analysis (OR = 0.309, P = 0.004; OR = 0.384, P = 0.004; and OR = 0.376, P = 0.022, respectively).
The concordance between Watson for Oncology and surgeons' hepatectomy recommendation for hepatocellular carcinoma was only 72%. Differences in practice patterns for HCC between the USA (where Watson for Oncology was calibrated) and China may be the major cause of discordance. Watson for Oncology still requires further improvement and localization to be widely applied in China.
随着诊断成像、围手术期护理和外科技术的提高，肝切除术的适应证和复杂性也在发展。然而，手术适应证仍存在争议，特别是对于一些复杂或晚期肝细胞癌。本研究旨在评估 Watson for Oncology（一种提供决策支持的认知技术）提出的肝切除术建议与我院外科医生为肝细胞癌患者确定的建议之间的一致性。
我们回顾性分析了 2008 年至 2016 年期间在南方医科大学珠江医院接受手术治疗并接受肝切除术的 243 例肝细胞癌患者。Watson for Oncology 将治疗方案分为三类：推荐、考虑和不推荐。如果 Watson for Oncology 将肝切除术建议指定为“推荐”或“考虑”，则认为治疗建议是一致的。我们还分析了可能影响一致性率的因素。
174 例患者的肝切除术建议一致。在考虑肿瘤数量（P=0.006）、肝切除术范围（P=0.009）和 BCLC 分期系统（P<0.001）时，一致组和不一致组之间的吻合率存在显著差异。Logistic 回归分析显示，在有多个肿瘤、大肝切除术和门静脉高压的患者中，一致性较低（OR=0.309，P=0.004；OR=0.384，P=0.004；OR=0.376，P=0.022）。
Watson for Oncology 与外科医生对肝细胞癌肝切除术建议的一致性仅为 72%。Watson for Oncology 校准所在的美国（美国）和中国之间 HCC 实践模式的差异可能是不一致的主要原因。Watson for Oncology 仍需要进一步改进和本地化，才能在中国广泛应用。
