Noji Takehiro, Uemura Satoko, Wiggers Jimme K, Tanaka Kimitaka, Nakanishi Yoshitsugu, Asano Toshimichi, Nakamura Toru, Tsuchikawa Takahiro, Okamura Keisuke, Olthof Pim B, Jarnagin William R, van Gulik Thomas M, Hirano Satoshi
Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, Japan.
Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Location AMC University of Amsterdam, Amsterdam, the Netherlands.
Hepatobiliary Surg Nutr. 2022 Jun;11(3):375-385. doi: 10.21037/hbsn-20-660.
Surgery for perihilar cholangiocarcinoma (PHCC) remains a challenging procedure with high morbidity and mortality. The Academic Medical Center (Amsterdam UMC) and Memorial Sloan Kettering Cancer Center proposed a postoperative mortality risk score (POMRS) and post-hepatectomy liver failure score (PHLFS) to predict patient outcomes. This study aimed to validate the POMRS and PHLFS for PHCC patients at Hokkaido University.
Medical records of 260 consecutive PHCC patients who had undergone major hepatectomy with extrahepatic bile duct resection without pancreaticoduodenectomy at Hokkaido University between March 2001 and November 2018 were evaluated to validate the PHLFS and POMRS.
The observed risks for PHLF were 13.7%, 24.5%, and 39.8% for the low-risk, intermediate-risk, and high-risk groups, respectively, in the study cohort. A receiver-operator characteristic (ROC) analysis revealed that the PHLFS had moderate predictive value, with an analysis under the curve (AUC) value of 0.62. Mortality rates based on the POMRS were 1.7%, 5%, and 5.1% for the low-risk, intermediate-risk, and high-risk groups, respectively. The ROC analysis demonstrated an AUC value of 0.58.
This external validation study showed that for PHLFS the threshold for discrimination in an Eastern cohort was reached (AUC >0.6), but it would require optimization of the model before use in clinical practice is acceptable. The POMRS were not applicable in the eastern cohort. Further external validation is recommended.
肝门部胆管癌（PHCC）手术仍然是一项具有挑战性的手术，发病率和死亡率很高。学术医疗中心（阿姆斯特丹大学医学中心）和纪念斯隆凯特琳癌症中心提出了术后死亡风险评分（POMRS）和肝切除术后肝功能衰竭评分（PHLFS）来预测患者预后。本研究旨在验证北海道大学PHCC患者的POMRS和PHLFS。
对2001年3月至2018年11月在北海道大学接受了肝外胆管切除但未行胰十二指肠切除术的260例连续PHCC患者的病历进行评估，以验证PHLFS和POMRS。
在研究队列中，低风险、中风险和高风险组的PHLF观察到的风险分别为13.7%、24.5%和39.8%。受试者工作特征（ROC）分析显示PHLFS具有中等预测价值，曲线下面积（AUC）值为0.62。基于POMRS的低风险、中风险和高风险组的死亡率分别为1.7%、5%和5.1%。ROC分析显示AUC值为0.58。
这项外部验证研究表明，对于PHLFS，在东方队列中达到了区分阈值（AUC>0.6），但在可接受用于临床实践之前，需要对模型进行优化。POMRS不适用于东方队列。建议进一步进行外部验证。
