Background and aims:Hepatocellular carcinoma(HCC)is a leading cause of cancer death globally.Despite improved surgical techniques,early post-hepatectomy mortality remains a critical concern.Current staging systems and...Background and aims:Hepatocellular carcinoma(HCC)is a leading cause of cancer death globally.Despite improved surgical techniques,early post-hepatectomy mortality remains a critical concern.Current staging systems and liver function classifications fail to estimate early mortality risk to guide surgical decision-making.We aimed to develop and validate an individualized online calculator to predict early post-hepatectomy mortality for HCC.Methods:Patients undergoing curative-intent hepatectomy for HCC from 2011 to 2021 at 11 Chinese centers were included.The training cohort comprised nine centers,while the external validation cohort included two centers.Multivariable logistic regression identified predictors of postoperative 90-day mortality,which were incorporated into an online calculator.Discrimination was assessed using the concordance index(C-index)and calibration by graphical plots.--Results:Among 4966 patients,90-day mortality was 4.1%.Predictors of 90-day mortality included patient performance status,prothrombin time,albumin-bilirubin(ALBI)grade,aspartate aminotransferase to platelet ratio index(APRI),tumor burden score and gross vascular invasion.The model demonstrated excellent discrimination in training and validation(C-index 0.816 and 0.801)cohorts.The proposed model outperformed staging systems(American Joint Committee on Cancer AJCC and Barcelona Clinic Liver Cancer BCLC)and liver function classifications(Child-Pugh,APRI,ALBI,and Fibrosis-4 Index FIB4)(p<0.001).Calibration was accurate in both cohorts.The calculator achieved sensitivity of 79.0%and specificity of 71.8%to identify highrisk patients.Decision curve analysis demonstrated that the model had superior net benefit compared with staging systems and liver function classifications.-Conclusions:An individualized online calculator was developed and validated to predict early post-hepatectomy mortality for HCC.By identifying high-risk patients,this tool may guide surgical decision-making.展开更多
基金supported by the Beijing Research Ward Excellence Program,BRWEP(BRWEP2024W032240108 for Wang S and BRWEP2024W032240103 for Jin S)Beijing Tsinghua Changgung Hospital Fund(Grant No.12025C01017 for Wang S)+6 种基金National Natural Science Foundation of China(No.81972726 and 82273074 for Yang T,No.81930119,No.82090050,and No.82090053 for Dong J,No.82241223 for Wang M,No.82000484 for Jin S)Dawn Project Foun-dation of Shanghai(No.21SG36 for Yang T)CAMS Innovation Fund for Medical Sciences(2019-I2M-5–056 for Dong J)Shanghai Health and Hygiene Discipline Leader Project(No.2022XD001 for Yang T)Shanghai Outstanding Academic Leader Program(No.23XD1424900 for Yang T)the Natural Science Foundation of Shanghai(No.22ZR1477900 for Wang M)Tsinghua University Initiative Scientific Research Program of Precision Medicine(No.2022TS014 for Jin S).
文摘Background and aims:Hepatocellular carcinoma(HCC)is a leading cause of cancer death globally.Despite improved surgical techniques,early post-hepatectomy mortality remains a critical concern.Current staging systems and liver function classifications fail to estimate early mortality risk to guide surgical decision-making.We aimed to develop and validate an individualized online calculator to predict early post-hepatectomy mortality for HCC.Methods:Patients undergoing curative-intent hepatectomy for HCC from 2011 to 2021 at 11 Chinese centers were included.The training cohort comprised nine centers,while the external validation cohort included two centers.Multivariable logistic regression identified predictors of postoperative 90-day mortality,which were incorporated into an online calculator.Discrimination was assessed using the concordance index(C-index)and calibration by graphical plots.--Results:Among 4966 patients,90-day mortality was 4.1%.Predictors of 90-day mortality included patient performance status,prothrombin time,albumin-bilirubin(ALBI)grade,aspartate aminotransferase to platelet ratio index(APRI),tumor burden score and gross vascular invasion.The model demonstrated excellent discrimination in training and validation(C-index 0.816 and 0.801)cohorts.The proposed model outperformed staging systems(American Joint Committee on Cancer AJCC and Barcelona Clinic Liver Cancer BCLC)and liver function classifications(Child-Pugh,APRI,ALBI,and Fibrosis-4 Index FIB4)(p<0.001).Calibration was accurate in both cohorts.The calculator achieved sensitivity of 79.0%and specificity of 71.8%to identify highrisk patients.Decision curve analysis demonstrated that the model had superior net benefit compared with staging systems and liver function classifications.-Conclusions:An individualized online calculator was developed and validated to predict early post-hepatectomy mortality for HCC.By identifying high-risk patients,this tool may guide surgical decision-making.
