Oji Kentaro, Urade Takeshi, Omiya Satoshi, Kido Masahiro, Komatsu Shohei, Gon Hidetoshi, Fukushima Kenji, Yanagimoto Hiroaki, Toyama Hirochika, Fukumoto Takumi
Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe University, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
Langenbecks Arch Surg. 2025 Apr 23;410(1):139. doi: 10.1007/s00423-025-03703-x.
To investigate the impact of textbook outcome (TO) achievement on survival post-liver resection for hepatocellular carcinoma (HCC) and explore the associated factors.
We retrospectively reviewed 330 patients diagnosed with HCC who underwent initial liver resection at our hospital between January 2011 and December 2019. We also investigated the achievement rates of five TOs and sub-analyzed the relationship between them and malnutrition. The patient's nutritional status was classified following the Global Leadership Initiative on Malnutrition (GLIM) criteria.
The TO achievement rate was 72.7%. In the prognostic analysis, the TO-achieving group showed significantly longer overall survival (OS) and recurrence-free survival (RFS). Significant differences in age, body mass index, weight loss, muscle mass, serum aspartate aminotransferase level, serum protein induced by vitamin K absence or antagonist-II, tumor characteristics, intraoperative blood loss, perioperative transfusion, and nutritional status were found between the groups.
TO achievement is associated with OS and RFS post-liver resection for HCC. The TO is valuable for evaluating treatment quality in liver resection. Additionally, malnutrition graded following the GLIM criteria, age, tumor stage, and intraoperative blood loss are independent factors for achieving a TO post-liver resection for HCC.
探讨教科书式预后（TO）达标对肝细胞癌（HCC）肝切除术后生存的影响，并探索相关因素。
我们回顾性分析了2011年1月至2019年12月期间在我院接受初次肝切除的330例诊断为HCC的患者。我们还调查了五项TO的达标率，并对它们与营养不良之间的关系进行了亚组分析。根据全球营养不良领导倡议（GLIM）标准对患者的营养状况进行分类。
TO达标率为72.7%。在预后分析中，TO达标组的总生存期（OS）和无复发生存期（RFS）显著更长。两组之间在年龄、体重指数、体重减轻、肌肉量、血清天冬氨酸转氨酶水平、维生素K缺乏或拮抗剂-II诱导的血清蛋白、肿瘤特征、术中失血、围手术期输血和营养状况方面存在显著差异。
TO达标与HCC肝切除术后的OS和RFS相关。TO对于评估肝切除的治疗质量具有重要价值。此外，根据GLIM标准分级的营养不良、年龄、肿瘤分期和术中失血是HCC肝切除术后实现TO的独立因素。
