Lin Kong-Ying, Liu Hong-Zhi, Liu Jian-Wei, Zhu Xiao-Dong, Pan Yang-Xun, Shen Shun-Li, Zhang Wei, Jin Ren-An, Han Chuang-Ye, Chen Jie, Zhang Xiao-Yun, Liang Bin-Yong, Zhang Yao-Dong, Ma Jian, Wang Nan-Ya, Li Dong-Xiao, Xiong Rui, Li Zhong-Chao, Li Jing-Dong, Zhang Zhi-Bo, Chen Jin-Hong, Chen Yu-Feng, Zheng Lu, Zhao Lei, Yin Tao, Li De-Yu, Zhang Lei, Li Xiang-Cheng, Huang Zhi-Yong, Wen Tian-Fu, Chen Ya-Jin, Peng Tao, Liang Xiao, Song Tian-Qiang, Kuang Ming, Xu Li, Wang Kui, Sun Hui-Chuan, Zeng Yong-Yi
Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350000, China; Fujian Provincial Liver Disease Research Center, Fuzhou, 350001, China.
Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350000, China.
Eur J Surg Oncol. 2025 Sep;51(9):110220. doi: 10.1016/j.ejso.2025.110220. Epub 2025 Jun 16.
Conversion therapy with tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs) offers the potential for curative resection in unresectable hepatocellular carcinoma (HCC). However, early recurrence (≤2 years) after conversion liver resection remains a major concern. This study aimed to develop and validate online preoperative and postoperative risk scores to predict early recurrence in patients undergoing conversion liver resection.
A total of 203 patients with initially unresectable HCC who underwent conversion liver resection following TKI and ICI therapy across 28 academic centers were analyzed. Independent predictors of early recurrence were identified using Cox proportional hazards analyses, and risk scores were developed and validated using the C-index, time-dependent AUC (tdAUC), and calibration curves.
Preoperative risk score model included the neutrophil-to-lymphocyte ratio (NLR) ≥ 1.39, multiple tumors, absence of radiographic response, and no alpha-fetoprotein (AFP) response. Postoperative risk score model included NLR ≥1.39, multiple tumors, no AFP response, active macrovascular invasion, and incomplete pathological response. The preoperative risk score had a C-index of 0.699 (training) and 0.681 (validation), while the postoperative risk score had a C-index of 0.739 (training) and 0.706 (validation). Both models demonstrated good predictive accuracy through tdAUC and calibration curves. Decision tree analysis stratified patients into distinct risk categories with significant differences in 2-year recurrence rates. All risk score models are available online for clinical use.
Online preoperative and postoperative risk scores provide valuable tools for predicting early recurrence in HCC patients after conversion liver resection, aiding in surgical decision-making and postoperative management.
酪氨酸激酶抑制剂（TKIs）和免疫检查点抑制剂（ICIs）的转化治疗为不可切除的肝细胞癌（HCC）实现根治性切除提供了可能。然而，转化肝切除术后的早期复发（≤2年）仍是一个主要问题。本研究旨在开发并验证术前和术后在线风险评分，以预测接受转化肝切除患者的早期复发。
分析了28个学术中心共203例最初不可切除的HCC患者，这些患者在接受TKI和ICI治疗后进行了转化肝切除。使用Cox比例风险分析确定早期复发的独立预测因素，并使用C指数、时间依赖性AUC（tdAUC）和校准曲线开发并验证风险评分。
术前风险评分模型包括中性粒细胞与淋巴细胞比值（NLR）≥1.39、多发肿瘤、无影像学反应以及甲胎蛋白（AFP）无反应。术后风险评分模型包括NLR≥1.39、多发肿瘤、AFP无反应、存在活跃的大血管侵犯以及病理反应不完全。术前风险评分的C指数在训练集为0.699，验证集为0.681；术后风险评分的C指数在训练集为0.739，验证集为0.706。两个模型通过tdAUC和校准曲线均显示出良好的预测准确性。决策树分析将患者分为不同的风险类别，2年复发率存在显著差异。所有风险评分模型均可在线获取以供临床使用。
术前和术后在线风险评分为预测HCC患者转化肝切除术后的早期复发提供了有价值的工具，有助于手术决策和术后管理。
