Departamento de Cirugía en Abdomen, Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Peru.
Unité Organisation Nucléaire et Oncogenèse, INSERM, Institut Pasteur, Paris, France.
HPB (Oxford). 2022 Feb;24(2):192-201. doi: 10.1016/j.hpb.2021.06.006. Epub 2021 Jun 19.
It has previously been demonstrated that a fraction of patients with hepatocellular carcinoma (HCC) > 10 cm can benefit from liver resection. However, there is still a lack of effective decision-making tools to inform intervention in these patients.
We analysed a comprehensive set of clinical data from 234 patients who underwent liver resection for HCC >10 cm at the National Cancer Institute of Peru between 1990 and 2015, monitored their survival, and constructed a nomogram to predict the surgical outcome based on preoperative variables.
We identified cirrhosis, multifocality, macroscopic vascular invasion, and spontaneous tumour rupture as independent predictors of survival and integrated them into a nomogram model. The nomogram's ability to forecast survival at 1, 3, and 5 years was subsequently confirmed with high concordance using an internal validation. Through applying this nomogram, we stratified three groups of patients with different survival probabilities.
We constructed a preoperative nomogram to predict long-term survival in patients with HCC >10 cm. This nomogram is useful in determining whether a patient with large HCC might truly benefit from liver resection, which is paramount in low- and middle-income countries where HCC is often diagnosed at advanced stages.
此前已经证实，部分直径>10cm 的肝细胞癌（HCC）患者可以从肝切除中获益。然而，目前仍缺乏有效的决策工具来告知这些患者的干预措施。
我们分析了 1990 年至 2015 年期间在秘鲁国家癌症研究所接受肝切除治疗>10cm HCC 的 234 例患者的综合临床数据，监测他们的生存情况，并构建了一个列线图，以根据术前变量预测手术结果。
我们确定了肝硬化、多灶性、肉眼血管侵犯和自发性肿瘤破裂是生存的独立预测因素，并将其整合到列线图模型中。通过内部验证，该列线图在预测 1、3 和 5 年生存率方面的能力得到了很好的确认。通过应用该列线图，我们将具有不同生存概率的三组患者分层。
我们构建了一个用于预测直径>10cm HCC 患者长期生存的术前列线图。该列线图有助于确定大肝癌患者是否真的可以从肝切除中获益，这在中低收入国家尤为重要，因为这些国家的 HCC 通常在晚期诊断。
