Xiao Han, Li Jia-Li, Chen Shu-Ling, Tang Mi-Mi, Zhou Qian, Wu Ting-Fan, Li Xin, Peng Zhen-Wei, Feng Shi-Ting, Peng Sui, Kuang Ming
Division of Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Department of Liver Surgery, Dongguan People's Hospital, Dongguan, China.
Front Oncol. 2021 Feb 26;11:569515. doi: 10.3389/fonc.2021.569515. eCollection 2021.
Previous studies demonstrated a promising prognosis in advanced hepatocellular carcinoma (HCC) patients who underwent surgery, yet a consensus of which population would benefit most from surgery is still unreached.
A total of 496 advanced HCC patients who initially underwent liver resection were consecutively collected. Least absolute shrinkage and selection operator (LASSO) regression was performed to select significant pre-operative factors for recurrence-free survival (RFS). A prognostic score constructed from these factors was used to divide patients into different risk groups. Survivals were compared between groups with log-rank test. The area under curves (AUC) of the time-dependent receiver operating characteristics was used to evaluate the predictive accuracy of prognostic score.
For the entire cohort, the median overall survival (OS) was 23.0 months and the median RFS was 12.1 months. Patients were divided into two risk groups according to the prognostic score constructed with ALBI score, tumor size, tumor-invaded liver segments, gamma-glutamyl transpeptidase, alpha fetoprotein, and portal vein tumor thrombus stage. The median RFS of the low-risk group was significantly longer than that of the high-risk group in both the training (10.1 vs 2.9 months, <0.001) and the validation groups (13.7 vs 4.6 months, =0.002). The AUCs of the prognostic score in predicting survival were 0.70 to 0.71 in the training group and 0.71 to 0.72 in the validation group.
Surgery could provide promising survival for HCC patients at an advanced stage. Our developed pre-operative prognostic score is effective in identifying advanced-stage HCC patients with better survival benefit for surgery.
既往研究表明，接受手术治疗的晚期肝细胞癌（HCC）患者预后良好，但对于哪类人群从手术中获益最大仍未达成共识。
连续收集496例最初接受肝切除术的晚期HCC患者。采用最小绝对收缩和选择算子（LASSO）回归分析筛选无复发生存期（RFS）的重要术前因素。根据这些因素构建预后评分，将患者分为不同风险组。采用对数秩检验比较组间生存率。采用时间依赖性受试者工作特征曲线下面积（AUC）评估预后评分的预测准确性。
在整个队列中，中位总生存期（OS）为23.0个月，中位RFS为12.1个月。根据ALBI评分、肿瘤大小、肿瘤侵犯肝段、γ-谷氨酰转肽酶、甲胎蛋白和门静脉癌栓分期构建的预后评分，将患者分为两个风险组。在训练组（10.1 vs 2.9个月，<0.001）和验证组（13.7 vs 4.6个月，=0.002）中，低风险组的中位RFS均显著长于高风险组。训练组预后评分预测生存的AUC为0.70至0.71，验证组为0.71至0.72。
手术可为晚期HCC患者提供良好的生存预后。我们开发的术前预后评分可有效识别从手术中生存获益更好的晚期HCC患者。
