Department of General Surgery, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, Taoyuan, Taiwan.
Division of Liver and Transplantation Surgery, Department of General Surgery, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, Taoyuan, Taiwan.
J Surg Oncol. 2020 Dec;122(7):1444-1452. doi: 10.1002/jso.26169. Epub 2020 Sep 1.
Precise prognostic prediction for an individual hepatocellular carcinoma (HCC) patient before and after liver resection is important. We aimed to establish simple prognostic models to predict disease-free survival (DFS) for these patients.
Six hundred and ninety-eight HCC patients with liver resections were reviewed. Preoperative (model 1) and postoperative (model 2) nomogram-based scoring systems were constructed by multivariate analyses, and DFS was estimated.
Among 698 patients, 490 (70.2%) patients had tumor recurrence at a median follow-up of 84.4 months. Risk factors of tumor recurrence in model 1 included viral hepatitis, platelet count, albumin, indocyanine green retention rate, multiplicity of tumor, and radiologic total tumor volume (TTV). Prognostic variables identified in model 2 were viral hepatitis, platelet count, multiplicity of tumor, cirrhosis, microvascular invasion, and pathologic TTV. By nomogram in model 1, the patients were classified into three groups with 5-year DFS of 61.0%, 35.7%, and 21.1%, respectively (P < .0001). In model 2, the patients were divided into five groups with 5-year DFS of 58.0%, 43.7%, 24.0%, 15.4%, and 0.0%, respectively (P < .0001).
Based on nomogram models, DFS for the patients who had liver resection for HCC can be predicted before liver resection and re-assessed after liver resection.
对肝癌（HCC）患者行肝切除术前和术后进行精确的预后预测非常重要。本研究旨在建立简单的预后模型，以预测这些患者的无病生存率（DFS）。
回顾性分析 698 例行肝切除术的 HCC 患者。通过多变量分析建立术前（模型 1）和术后（模型 2）列线图评分系统，并估计 DFS。
在 698 例患者中，490 例（70.2%）患者在中位随访 84.4 个月时发生肿瘤复发。模型 1 中肿瘤复发的危险因素包括病毒性肝炎、血小板计数、白蛋白、吲哚菁绿保留率、肿瘤数量和影像学总肿瘤体积（TTV）。模型 2 中确定的预后变量包括病毒性肝炎、血小板计数、肿瘤数量、肝硬化、微血管侵犯和病理 TTV。通过模型 1 中的列线图，患者被分为三组，5 年 DFS 分别为 61.0%、35.7%和 21.1%（P<0.0001）。在模型 2 中，患者被分为五组，5 年 DFS 分别为 58.0%、43.7%、24.0%、15.4%和 0.0%（P<0.0001）。
基于列线图模型，可在肝切除术前预测 HCC 患者行肝切除术后的 DFS，并在术后重新评估。
