Kawashima Jun, Endo Yutaka, Khalil Mujtaba, Woldesenbet Selamawit, Akabane Miho, Ruzzenente Andrea, Ratti Francesca, Marques Hugo, Oliveira Sara, Balaia Jorge, Cauchy François, Lam Vincent, Poultsides George, Kitago Minoru, Popescu Irinel, Martel Guillaume, Gleisner Ana, Hugh Thomas J, Aldrighetti Luca, Endo Itaru, Pawlik Timothy M
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH; Department of Gastroenterological Surgery, Yokohama City University, Yokohama, Japan. Electronic address: https://twitter.com/Jun_Kawashima_x.
Department of Transplant Surgery, University of Rochester Medical Center, Rochester, NY. Electronic address: https://twitter.com/YutakaEndoSurg.
Surgery. 2025 Sep;185:109527. doi: 10.1016/j.surg.2025.109527. Epub 2025 Jun 27.
We sought to develop and externally validate a preoperative model for predicting the risk of severe complications and very early recurrence after liver resection for hepatocellular carcinoma.
Patients who underwent curative-intent hepatectomy for hepatocellular carcinoma between 2000 and 2023 were identified using a multi-institutional international database. Preoperative characteristics were assessed in relation to severe complications (defined as complications with a Clavien-Dindo classification III or greater) and very early recurrence (recurrence within 6 months after surgery) using multivariable analysis. Predictive models for severe complications and very early recurrence were developed and externally validated.
Among 969 patients, 97 patients (10.0%) experienced severe complications, and 116 patients (12.0%) developed very early recurrence. On multivariable analysis, American Society of Anesthesiologists class >2 and greater albumin-bilirubin score were associated with severe complications. Meanwhile, a greater albumin-bilirubin score and higher tumor burden score were associated with very early recurrence. A predictive model for very early recurrence was able to stratify patients relative to their risk for recurrence: low-risk (6-month recurrence-free survival, 94.1%), medium-risk (6-month recurrence-free survival, 86.0%), and high-risk (6-month recurrence-free survival, 67.1%). A total of 74 patients (7.6%) had an unfavorable risk profile (severe complication risk ≥30% and high-risk for very early recurrence). The discriminative accuracy of the severe complications (training: area under the curve, 0.69; external validation: area under the curve, 0.80) and very early recurrence (training: C-index: 0.65; external validation: C-index: 0.71) models were favorable (see online calculator: https://junkawashima.shinyapps.io/HCC_comp_VER/).
An easy-to-use online calculator stratified patients relative to short- and long-term risks, identifying a subset of patients at a high risk of severe complications and very early recurrence who were unlikely to benefit from surgical resection.
我们试图开发并外部验证一种术前模型，以预测肝细胞癌肝切除术后严重并发症和极早期复发的风险。
利用一个多机构国际数据库识别出2000年至2023年间接受肝细胞癌根治性肝切除术的患者。通过多变量分析评估术前特征与严重并发症（定义为Clavien-Dindo分类III级或更高的并发症）和极早期复发（术后6个月内复发）的关系。开发并外部验证了严重并发症和极早期复发的预测模型。
在969例患者中，97例（10.0%）发生严重并发症，116例（12.0%）出现极早期复发。多变量分析显示，美国麻醉医师协会分级>2和更高的白蛋白-胆红素评分与严重并发症相关。同时，更高的白蛋白-胆红素评分和更高的肿瘤负荷评分与极早期复发相关。极早期复发的预测模型能够根据患者的复发风险进行分层：低风险（6个月无复发生存率，94.1%）、中风险（6个月无复发生存率，86.0%）和高风险（6个月无复发生存率，67.1%）。共有74例患者（7.6%）具有不良风险特征（严重并发症风险≥30%且极早期复发高风险）。严重并发症模型（训练：曲线下面积，0.69；外部验证：曲线下面积，0.80）和极早期复发模型（训练：C指数：0.65；外部验证：C指数：0.71）的判别准确性良好（见在线计算器：https://junkawashima.shinyapps.io/HCC_comp_VER/）。
一个易于使用的在线计算器根据患者的短期和长期风险进行分层，识别出一组严重并发症和极早期复发高风险的患者，这些患者不太可能从手术切除中获益。
