R0肝切除术后预测肝细胞癌门静脉癌栓术后早期复发的列线图

StephenW

Eur J Surg Oncol. 2019 Apr 3. pii: S0748-7983(19)30388-9. doi: 10.1016/j.ejso.2019.03.043. [Epub ahead of print]
A nomogram to predict early postoperative recurrence of hepatocellular carcinoma with portal vein tumour thrombus after R0 liver resection: A large-scale, multicenter study.
Zhang XP1, Chen ZH1, Zhou TF2, Li LQ3, Chen MS4, Wen TF5, Shi J1, Guo WX1, Wu MC1, Lau WY6, Cheng SQ7; Chinese National Research Cooperative Group for Diagnosis and Treatment of Hepatocellular Carcinoma with Tumour Thrombus.
Author information

1
    Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University Shanghai, China.
2
    The No.313 Hospital of PLA, Huludao, Liaoning, China.
3
    Department of Hepatobiliary Surgery, Affiliated Tumour Hospital of Guangxi Medical University, Nanning, China.
4
    Department of Hepatobiliary Oncology of Sun Yat-sen University Cancer Center, Guangzhou, China.
5
    Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, China.
6
    Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University Shanghai, China; Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
7
    Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University Shanghai, China. Electronic address: [email protected].

Abstract
BACKGROUND:

Portal vein tumour thrombus (PVTT) is a significant poor prognostic factor for hepatocellular carcinoma (HCC). Patients with PVTT limited to a first-order branch or above of the main portal vein (MPV) could benefit from R0 liver resection (LR). A nomogram is needed to predict early postoperative recurrence (ER) in HCC patients with PVTT and to guide selection of these patients for adjuvant therapy to reduce postoperative recurrence risks.
METHODS:

HCC patients with PVTT limited to a first-order branch or above of the MPV after R0 LR as an initial therapy were included. A nomogram using data from a retrospective training cohort was developed with the Cox regression model. The model was tested in a prospective internal validation cohort and three external validation cohorts.
RESULTS:

Of 979 patients, 657 developed postoperative ER (67.1%). ER occurred in 165 of 264 patients (62.5%) in the training cohort, 146 of 218 patients (70.0%) in the internal validation cohort, and 204 of 284 patients (71.8%), 77 of 113 patients (68.1%), and 65 of 100 patients (65%) in the three external validation cohorts, respectively. The nomogram included the following variables: hepatitis B surface antigen (HBsAg), PVTT, HBV DNA, satellite nodules, α-fetoprotein, and tumour diameter. The ROC were 0.836, 0.763, 0.802, 0.837, and 0.846 in predicting ER in the five respective cohorts.
CONCLUSION:

A nomogram was developed and validated to predict postoperative ER in patients with HCC with PVTT after R0 LR. This nomogram could select appropriate patients with high ER risks for postoperative adjuvant therapy.

Copyright © 2019 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
KEYWORDS:

Early recurrence; Hepatocellular carcinoma; Nomogram; Portal vein tumour thrombus; R0 liver resection

PMID:
    30982657
DOI:
    10.1016/j.ejso.2019.03.043

StephenW

Eur J Surg Oncol。 2019年4月3日.pii：S0748-7983（19）30388-9。 doi：10.1016 / j.ejso.2019.03.043。 [印刷前的电子版]
R0肝切除术后预测肝细胞癌门静脉癌栓术后早期复发的列线图：一项大规模，多中心研究。
Zhang XP1，Chen ZH1，Zhou TF2，Li LQ3，Chen MS4，Wen TF5，Shi J1，Guo WX1，Wu MC1，Lau WY6，Cheng SQ7;中国国家肿瘤血栓治疗肝细胞癌研究合作组。
作者信息

1
    上海第二军医大学东方肝胆外科医院肝外科六。
2
    中国人民解放军第313医院，辽宁葫芦岛。
3
    广西医科大学附属肿瘤医院肝胆外科，南宁
4
    中山大学肿瘤防治中心肝胆肿瘤科，广州
五
    四川大学华西医院肝外科和肝移植中心，四川成都610041
6
    上海第二军医大学东方肝胆外科医院肝外科，上海;香港中文大学医学院，中国香港沙田。
7
    上海第二军医大学东方肝胆外科医院肝外科六。电子地址：[email protected]。

抽象
背景：

门静脉癌栓（PVTT）是肝细胞癌（HCC）的重要不良预后因素。 PVTT受限于主要门静脉（MPV）的一级分支或以上的患者可受益于R0肝切除术（LR）。需要列线图来预测PVTT的HCC患者术后早期复发（ER），并指导选择这些患者进行辅助治疗以减少术后复发风险。
方法：

在R0 LR作为初始治疗后，包括PVTT的HCC患者限于MPV的一级分支或以上。使用Cox回归模型开发了使用来自回顾性训练群组的数据的列线图。该模型在前瞻性内部验证队列和三个外部验证队列中进行了测试。
结果：

在979例患者中，657例发生术后ER（67.1％）。 ER训练队列中264例患者中有165例（62.5％），内部验证队列中218例患者中有146例（70.0％），284例患者中有204例（71.8％），113例患者中有77例（68.1％），在三个外部验证队列中分别有100名患者中的65名（65％）。诺模图包括以下变量：乙型肝炎表面抗原（HBsAg），PVTT，HBV DNA，卫星结节，α-胎蛋白和肿瘤直径。在预测5个相应组群中的ER时，ROC分别为0.836,0.763,0.802,0.837和0.846。
结论：

开发并验证了诺模图，以预测R0 LR后患有PVTT的HCC患者的术后ER。该列线图可以选择合适的ER风险高的患者进行术后辅助治疗。

版权所有©2019 Elsevier Ltd，BASO~癌症外科协会和欧洲外科肿瘤学会。版权所有。
关键词：

早期复发;肝细胞癌;列线图;门静脉癌栓; R0肝切除术

结论：
    30982657
DOI：
    10.1016 / j.ejso.2019.03.043

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