Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan.
Department of Biostatistics, School of Public Health, the University of Tokyo, Tokyo, Japan.
Am J Gastroenterol. 2021 Aug 1;116(8):1698-1708. doi: 10.14309/ajg.0000000000001256.
Most studies predicting survival after resection, transarterial chemoembolization (TACE), and ablation analyzed diameter and number of hepatocellular carcinomas (HCCs) as dichotomous variables, resulting in an underestimation of risk variation. We aimed to develop and validate a new prognostic model for patients with HCC using largest diameter and number of HCCs as continuous variables.
The prognostic model was developed using data from patients undergoing resection, TACE, and ablation in 645 Japanese institutions. The model results were shown after balanced using the inverse probability of treatment-weighted analysis and were externally validated in an international multi-institution cohort.
Of 77,268 patients, 43,904 patients, including 15,313 (34.9%) undergoing liver resection, 13,375 (30.5%) undergoing TACE, and 15,216 (34.7%) undergoing ablation, met the inclusion criteria. Our model (http://www.u-tokyo-hbp-transplant-surgery.jp/about/calculation.html) showed that the 5-year overall survival (OS) in patients with HCC undergoing these procedures decreased with progressive incremental increases in diameter and number of HCCs. For patients undergoing resection, the inverse probability of treatment-weighted-adjusted 5-year OS probabilities were 10%-20% higher compared with patients undergoing TACE for 1-6 HCC lesions <10 cm and were also 10%-20% higher compared with patients undergoing ablation when the HCC diameter was 2-3 cm. For patients undergoing resection and TACE, the model performed well in the external cohort.
Our novel prognostic model performed well in predicting OS after resection and TACE for HCC and demonstrated that resection may have a survival benefit over TACE and ablation based on the diameter and number of HCCs.
大多数预测肝癌切除术、经动脉化疗栓塞术（TACE）和消融术后生存的研究均将肝癌（HCC）的直径和数量分析为二分类变量，从而低估了风险变化。我们旨在使用最大直径和 HCC 数量作为连续变量为 HCC 患者开发和验证新的预后模型。
该预后模型使用来自 645 家日本机构接受切除术、TACE 和消融术的患者的数据进行开发。在使用逆概率治疗加权分析进行平衡后显示模型结果，并在国际多机构队列中进行外部验证。
在 77268 例患者中，有 43904 例患者符合纳入标准，包括 15313 例（34.9%）接受肝切除术、13375 例（30.5%）接受 TACE 术和 15216 例（34.7%）接受消融术。我们的模型（http://www.u-tokyo-hbp-transplant-surgery.jp/about/calculation.html）显示，接受这些治疗的 HCC 患者的 5 年总生存率（OS）随 HCC 直径和数量的逐渐增加而降低。对于接受切除术的患者，与接受 TACE 治疗 1-6 个<10cm 的 HCC 病变的患者相比，经治疗加权调整的 5 年 OS 概率提高了 10%-20%，与直径为 2-3cm 的 HCC 患者相比，也提高了 10%-20%。对于接受切除术和 TACE 的患者，该模型在外部队列中表现良好。
我们的新型预后模型在预测 HCC 切除术和 TACE 后的 OS 方面表现良好，并表明基于 HCC 的直径和数量，切除术可能比 TACE 和消融术具有生存优势。
