Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China.
Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China.
BMC Surg. 2022 Jun 17;22(1):233. doi: 10.1186/s12893-022-01682-0.
Postoperative early recurrence (ER) is a major obstacle to long-term survival after curative liver resection (LR) in patients with hepatocellular carcinoma (HCC). This study aimed to establish preoperative and postoperative nomograms to predict ER in HCC without macrovascular invasion.
Patients who underwent curative LR for HCC between January 2012 and December 2016 were divided into training and internal prospective validation cohorts. Nomograms were constructed based on independent risk factors derived from the multivariate logistic regression analyses in the training cohort. The predictive performances of the nomograms were validated using the internal prospective validation cohort.
In total, 698 patients fulfilled the eligibility criteria. Among them, 265 of 482 patients (55.0%) in the training cohort and 120 of 216 (55.6%) patients in the validation cohort developed ER. The preoperative risk factors associated with ER were age, alpha-fetoprotein, tumor diameter, and tumor number, and the postoperative risk factors associated with ER were age, tumor diameter, tumor number, microvascular invasion, and differentiation. The pre- and postoperative nomograms based on these factors showed good accuracy, with concordance indices of 0.712 and 0.850 in the training cohort, respectively, and 0.754 and 0.857 in the validation cohort, respectively. The calibration curves showed optimal agreement between the predictions by the nomograms and actual observations. The area under the receiver operating characteristic curves of the pre- and postoperative nomograms were 0.721 and 0.848 in the training cohort, respectively, and 0.754 and 0.844 in the validation cohort, respectively.
The nomograms constructed in this study showed good performance in predicting ER for HCC without macrovascular invasion before and after surgery. These nomograms would be helpful for doctors when determining treatments and selecting patients for regular surveillance or administration of adjuvant therapies.
术后早期复发（ER）是肝癌患者根治性肝切除（LR）后长期生存的主要障碍。本研究旨在建立预测无大血管侵犯的 HCC 患者 ER 的术前和术后列线图。
2012 年 1 月至 2016 年 12 月期间，对接受根治性 LR 治疗 HCC 的患者进行了回顾性分析，将患者分为训练队列和内部前瞻性验证队列。基于训练队列中多变量逻辑回归分析得出的独立危险因素，建立了列线图。使用内部前瞻性验证队列验证了列线图的预测性能。
共纳入 698 例符合条件的患者，其中训练队列 482 例患者中有 265 例（55.0%），验证队列 216 例患者中有 120 例（55.6%）发生 ER。与 ER 相关的术前危险因素包括年龄、甲胎蛋白、肿瘤直径和肿瘤数量，与 ER 相关的术后危险因素包括年龄、肿瘤直径、肿瘤数量、微血管侵犯和分化程度。基于这些因素建立的术前和术后列线图具有较好的准确性，在训练队列中的一致性指数分别为 0.712 和 0.850，在验证队列中的一致性指数分别为 0.754 和 0.857。校准曲线显示列线图预测值与实际观察值之间具有最佳一致性。训练队列中术前和术后列线图的受试者工作特征曲线下面积分别为 0.721 和 0.848，验证队列中分别为 0.754 和 0.844。
本研究建立的列线图在预测无大血管侵犯的 HCC 患者术前和术后 ER 方面具有良好的性能。这些列线图将有助于医生在确定治疗方案和选择患者进行常规监测或辅助治疗时提供参考。
