Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Ann Surg Oncol. 2021 Nov;28(12):7624-7633. doi: 10.1245/s10434-021-10142-7. Epub 2021 May 21.
Extrahepatic recurrence of hepatocellular carcinoma (HCC) after surgical resection is associated with unfavorable prognosis. The objectives of the current study were to identify the risk factors and develop a nomogram for the prediction of extrahepatic recurrence after initial curative surgery.
A total of 635 patients who underwent curative-intent resection for HCC between 2000 and 2017 were identified from an international multi-institutional database. The clinicopathological characteristics, risk factors, and long-term survival of patients with extrahepatic recurrence were analyzed. A nomogram for the prediction of extrahepatic recurrence was established and validated in 144 patients from an external cohort.
Among the 635 patients in the derivative cohort, 283 (44.6%) experienced recurrence. Among patients who recurred, 80 (28.3%) patients had extrahepatic ± intrahepatic recurrence, whereas 203 (71.7%) had intrahepatic recurrence only. Extrahepatic recurrence was associated with more advanced initial tumor characteristics, early recurrence, and worse prognosis versus non-extrahepatic recurrence. A nomogram for the prediction of extrahepatic recurrence was developed using the β-coefficients from the identified risk factors, including neutrophil-to-lymphocyte ratio, multiple lesions, tumor size, and microvascular invasion. The nomogram demonstrated good ability to predict extrahepatic recurrence (c-index: training cohort 0.786; validation cohort: 0.845). The calibration plots demonstrated good agreement between estimated and observed extrahepatic recurrence (p = 0.658).
An externally validated nomogram was developed with good accuracy to predict extrahepatic recurrence following curative-intent resection of HCC. This nomogram may help identify patients at high risk of extrahepatic recurrence and guide surveillance protocols as well as adjuvant treatments.
肝癌（HCC）根治性切除术后肝外复发与不良预后相关。本研究旨在确定肝外复发的风险因素，并建立预测初始根治性手术后肝外复发的列线图。
从一个国际多机构数据库中确定了 2000 年至 2017 年期间接受根治性切除 HCC 的 635 例患者。分析了肝外复发患者的临床病理特征、风险因素和长期生存情况。在来自外部队列的 144 例患者中建立并验证了预测肝外复发的列线图。
在推导队列的 635 例患者中，283 例（44.6%）发生了复发。在复发患者中，80 例（28.3%）患者有肝外和/或肝内复发，而 203 例（71.7%）患者仅有肝内复发。肝外复发与初始肿瘤特征更晚期、早期复发和预后较差相关。使用确定的风险因素的β系数，包括中性粒细胞与淋巴细胞比值、多发病灶、肿瘤大小和微血管侵犯，建立了预测肝外复发的列线图。该列线图具有良好的预测肝外复发能力（训练队列的 C 指数：0.786；验证队列：0.845）。校准图表明，估计的肝外复发与观察到的肝外复发之间具有良好的一致性（p=0.658）。
建立了一种具有良好准确性的外部验证列线图，可预测 HCC 根治性切除术后肝外复发。该列线图可能有助于识别肝外复发风险较高的患者，并指导监测方案和辅助治疗。
