列线图预测肝癌患者肝切除术后肝功能不全风险和长期生存的建立与验证。
Development and Validation of a Nomogram to Preoperatively Estimate Post-hepatectomy Liver Dysfunction Risk and Long-term Survival in Patients With Hepatocellular Carcinoma.
机构信息
Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China.
Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Ministry of Education, Nanning, China.
出版信息
Ann Surg. 2021 Dec 1;274(6):e1209-e1217. doi: 10.1097/SLA.0000000000003803.
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.
目的
建立一个列线图，以评估肝癌患者肝切除术前发生 SPLD（国际肝脏外科研究组定义的 B 或 C 级）和长期生存的风险。
背景
SPLD 是肝切除术后死亡的主要原因。决定将 HCC 患者转介行肝切除术主要基于生存获益和 SPLD 风险。术前预测 SPLD 风险具有重要意义。
方法
共纳入 2071 例连续接受 HCC 肝切除术的患者，并将其随机分为开发队列（n = 1036）和内部验证队列（n = 1035）。另外招募了来自另一个中心的 590 例患者作为外部验证队列。基于多变量逻辑回归分析确定的 SPLD 独立术前预测因素，建立了一个列线图。
结果
开发、内部和外部验证队列的 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、临床显著门静脉高压和大切除术为 SPLD 的独立预测因素。纳入这些变量后，该列线图在预测 3 个队列中的 SPLD 时具有良好的一致性统计量，分别为 0.883、0.851 和 0.856。其在预测 SPLD、90 天死亡率和总生存期（OS）方面的表现优于 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。以列线图评分为 137 分，患者分为 SPLD 低风险和高风险。高危患者的 OS 也降低。
结论
该列线图在预测 SPLD 和 OS 方面均表现良好。它可以帮助外科医生选择适合进行肝切除术的 HCC 患者。
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