Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, China.
Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, China.
Int J Cancer. 2021 Jul 1;149(1):127-138. doi: 10.1002/ijc.33516. Epub 2021 Feb 27.
The population of patients with huge hepatocellular carcinoma (H-HCC diameter > 10.0 cm) is an odd group that is not well adjudicated in the current staging systems, whose prognosis after curative resection varies. We aimed to develop novel models to predict the long-term outcomes of patients with H-HCC without portal vein tumor thrombus after hepatectomy. There were 1076 H-HCC patients enrolled who underwent curative liver resection in five institutions in China. In total, 670 patients were recruited from our center and randomly divided into the training cohort (n = 502) and internal validation (n = 168) cohorts. Additionally, 406 patients selected from other four centers as the external validation cohort. Novel models were constructed based on independent preoperative and postoperative predictors of postsurgical recurrence (PSR) and postsurgical mortality (PSM) determined in multivariable cox regression analysis. The predictive accuracy and discriminative ability of the model were measured using Harrell's concordance index (C index) and calibration curve and compared with five conventional HCC staging systems. PSR model and PSM model were constructed based on tumor number, microscopic vascular invasion, tumor differentiation, preoperative alpha-fetoprotein level, albumin-bilirubin grade, liver segment invasion, neutrophil-to-lymphocyte ratio or platelet-to-neutrophil ratio, and surgical margin or intraoperative blood transfusion. The C-indexes were 0.84 (95% CI, 0.78-0.90) and 0.85 (95% CI, 0.78-0.91) for the PSR and PSM models, respectively, which were substantially higher than those of the five conventional HCC staging systems (0.63-0.75 for PSR; 0.66-0.77 for PSM). The two novel models achieved more accurate prognostic predictions of PSR and PSM for H-HCC patients after curative liver resection.
巨大肝细胞癌（H-HCC 直径>10.0cm）患者人群是一个特殊的群体，目前的分期系统对此类患者的评估并不完善，其根治性切除术后的预后也各不相同。我们旨在开发新的模型来预测无门静脉癌栓的巨大 HCC 患者根治性切除术后的长期预后。本研究纳入了在中国 5 家机构接受根治性肝切除术的 1076 例 H-HCC 患者。其中，我们中心共纳入 670 例患者，并将其随机分为训练队列（n=502）和内部验证队列（n=168）。此外，还从其他 4 家中心纳入 406 例患者作为外部验证队列。基于多变量 COX 回归分析确定的与术后复发（PSR）和术后死亡（PSM）相关的独立术前和术后预测因素，构建了新模型。使用 Harrell 一致性指数（C 指数）和校准曲线来衡量模型的预测准确性和区分能力，并与 5 种传统 HCC 分期系统进行比较。PSR 模型和 PSM 模型是基于肿瘤数量、镜下血管侵犯、肿瘤分化、术前甲胎蛋白水平、白蛋白-胆红素分级、肝段侵犯、中性粒细胞与淋巴细胞比值或血小板与中性粒细胞比值以及手术切缘或术中输血构建的。PSR 和 PSM 模型的 C 指数分别为 0.84（95%CI，0.78-0.90）和 0.85（95%CI，0.78-0.91），明显高于 5 种传统 HCC 分期系统（PSR 为 0.63-0.75；PSM 为 0.66-0.77）。这两种新模型能够更准确地预测 H-HCC 患者根治性切除术后的 PSR 和 PSM。
