Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan.
Department of Biostatistics, School of Public Health, University of Tokyo, Tokyo, Japan.
Br J Surg. 2021 Apr 30;108(4):412-418. doi: 10.1093/bjs/znaa109.
Surgical treatment for hepatocellular carcinoma (HCC) is advancing, but a robust prediction model for survival after resection is not available. The aim of this study was to propose a prognostic grading system for resection of HCC.
This was a retrospective, multicentre study of patients who underwent first resection of HCC with curative intent between 2000 and 2007. Patients were divided randomly by a cross-validation method into training and validation sets. Prognostic factors were identified using a Cox proportional hazards model. The predictive model was built by decision-tree analysis to define the resection grades, and subsequently validated.
A total of 16 931 patients from 795 hospitals were included. In the training set (8465 patients), four surgical grades were classified based on prognosis: grade A1 (1236 patients, 14.6 per cent; single tumour 3 cm or smaller and anatomical R0 resection); grade A2 (3614, 42.7 per cent; single tumour larger than 3 cm, or non-anatomical R0 resection); grade B (2277, 26.9 per cent; multiple tumours, or vascular invasion, and R0 resection); and grade C (1338, 15.8 per cent; multiple tumours with vascular invasion and R0 resection, or R1 resection). Five-year survival rates were 73.9 per cent (hazard ratio (HR) 1.00), 64.7 per cent (HR 1.51, 95 per cent c.i. 1.29 to 1.78), 50.6 per cent (HR 2.53, 2.15 to 2.98), and 34.8 per cent (HR 4.60, 3.90 to 5.42) for grades A1, A2, B, and C respectively. In the validation set (8466 patients), the grades had equivalent reproducibility for both overall and recurrence-free survival (all P < 0.001).
This grade is used to predict prognosis of patients undergoing resection of HCC.
肝细胞癌（HCC）的外科治疗正在不断发展，但目前仍缺乏一种可靠的术后生存预测模型。本研究旨在提出一种 HCC 切除术后的预后分级系统。
这是一项回顾性、多中心研究，纳入了 2000 年至 2007 年间接受根治性 HCC 切除术的患者。采用交叉验证方法将患者随机分为训练集和验证集。采用 Cox 比例风险模型确定预后因素。通过决策树分析建立预测模型，以定义切除等级，并进行验证。
共纳入来自 795 家医院的 16931 例患者。在训练集中（8465 例患者），根据预后将 4 个手术等级分为：A1 级（1236 例，占 14.6%；单个肿瘤直径 3cm 或更小，解剖性 R0 切除）；A2 级（3614 例，占 42.7%；单个肿瘤直径大于 3cm，或非解剖性 R0 切除）；B 级（2277 例，占 26.9%；多发肿瘤，或血管侵犯，R0 切除）；C 级（1338 例，占 15.8%；多发肿瘤伴血管侵犯和 R0 切除，或 R1 切除）。5 年生存率分别为 73.9%（风险比[HR]1.00）、64.7%（HR 1.51，95%置信区间[CI]1.29 至 1.78）、50.6%（HR 2.53，2.15 至 2.98）和 34.8%（HR 4.60，3.90 至 5.42），分别对应 A1、A2、B 和 C 级。在验证集中（8466 例患者），各等级对总生存和无复发生存的预测结果均具有等效的可重复性（均 P<0.001）。
该分级系统可用于预测接受 HCC 切除术患者的预后。
