开发出诺模图以预测Child-Pugh B肝硬化肝癌切除术后的结局

StephenW

Development of a nomogram to predict outcome after liver resection for hepatocellular carcinoma in Child-Pugh B cirrhosis [url=]Giammauro Berardi[/url]1,2,3
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DOI: https://doi.org/10.1016/j.jhep.2019.08.032 |

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Highlights

• •Liver resection for hepatocellular carcinoma in Child-Pugh B cirrhosis should be considered after careful patient selection.
• •Patient characteristics, tumor pattern, liver function and surgical approach should be considered as selection criteria.
• •Nomograms to predict surgical risks and survival may help in treatment allocation.
  

Background & AimsTreatment allocation in patients with hepatocellular carcinoma (HCC) on a background of Child-Pugh B (CP-B) cirrhosis is controversial. Liver resection has been proposed in small series with acceptable outcomes, but data are limited. The aim of this study was to evaluate the outcomes of patients undergoing liver resection for HCC in CP-B cirrhosis, focusing on the surgical risks and survival.


MethodsPatients were retrospectively pooled from 14 international referral centers from 2002 to 2017. Postoperative and oncological outcomes were investigated. Prediction models for surgical risks, disease-free survival and overall survival were constructed.


ResultsA total of 253 patients were included, of whom 57.3% of patients had a preoperative platelet count <100,000/mm3, 43.5% had preoperative ascites, and 56.9% had portal hypertension. A minor hepatectomy was most commonly performed (84.6%) and 122 (48.2%) were operated on by minimally invasive surgery (MIS). Ninety-day mortality was 4.3% with 6 patients (2.3%) dying from liver failure. One hundred and eight patients (42.7%) experienced complications, of which the most common was ascites (37.5%). Patients undergoing major hepatectomies had higher 90-day mortality (10.3% vs. 3.3%; p = 0.04) and morbidity rates (69.2% vs. 37.9%; p <0.001). Patients undergoing an open hepatectomy had higher morbidity (52.7% vs. 31.9%; p = 0.001) than those undergoing MIS. A prediction model for surgical risk was constructed (https://childb.shinyapps.io/morbidity/). The 5-year overall survival rate was 47%, and 56.9% of patients experienced recurrence. Prediction models for overall survival (https://childb.shinyapps.io/survival/) and disease-free survival (https://childb.shinyapps.io/DFsurvival/) were constructed.


ConclusionsLiver resection should be considered for patients with HCC and CP-B cirrhosis after careful selection according to patient characteristics, tumor pattern and liver function, while aiming to minimize surgical stress. An estimation of the surgical risk and survival advantage may be helpful in treatment allocation, eventually improving postoperative morbidity and achieving safe oncological outcomes.


Lay summaryLiver resection for hepatocellular carcinoma in advanced cirrhosis (Child-Pugh B score) is associated with a high rate of postoperative complications. However, due to the limited therapeutic alternatives in this setting, recent studies have shown promising results after accurate patient selection. In our international multicenter study, we provide 3 clinical models to predict postoperative surgical risks and long-term survival following liver resection, with the aim of improving treatment allocation and eventually clinical outcomes.



Keywords:                [url=https://www.journal-of-hepatology.eu/action/doSearch?searchType=quick&occurrences=all<rlSrch=true&searchScope=fullSite&searchText=Hepatocellular carcinoma&code=jhepat-site]Hepatocellular carcinoma[/url], [url=https://www.journal-of-hepatology.eu/action/doSearch?searchType=quick&occurrences=all<rlSrch=true&searchScope=fullSite&searchText=Liver resection&code=jhepat-site]Liver resection[/url], [url=https://www.journal-of-hepatology.eu/action/doSearch?searchType=quick&occurrences=all<rlSrch=true&searchScope=fullSite&searchText=Advanced liver cirrhosis&code=jhepat-site]Advanced liver cirrhosis[/url], [url=https://www.journal-of-hepatology.eu/action/doSearch?searchType=quick&occurrences=all<rlSrch=true&searchScope=fullSite&searchText=Child-Pugh B&code=jhepat-site]Child-Pugh B[/url]

StephenW

开发出诺模图以预测Child-Pugh B肝硬化肝癌切除术后的结局
Giammauro Berardi1,2,3
，Zenichi Morise4
，Carlo Sposito5
，五十岚和晴3
瓦伦蒂娜（Valentina Panetta）6
，伊拉里亚·西蒙内利6
，Sungho Kim7
，Brian K.P. Goh8
，久保昭二9
田中正吾9
，武田丰
，朱塞佩·玛丽亚·埃托雷11
格里高里·威尔逊（Gregory C.Wilson）12
，Matteo Cimino13
，郑中业8
圭多·托尔兹利（Guido Torzilli）13
，陈敦祥14
，广典Kaneko15
，文森佐·马扎费罗5
大卫·盖勒（David A.Geller）12
，韩浩Se7
，金泽明重
，和歌林
，Roberto Ivan Troisi1,2,17，low asterisk，'有关作者Roberto Ivan Troisi的通讯信息给作者Roberto Ivan Troisi发电子邮件
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DOI：https：//doi.org/10.1016/j.jhep.2019.08.032 |
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强调

    •仔细选择患者后，应考虑肝切除术治疗Child-Pugh B肝硬化的肝细胞癌。
    •患者的特征，肿瘤类型，肝功能和手术方式应作为选择标准。
    •用诺法图预测手术风险和生存率可能有助于分配治疗方案。

背景与目标

在Child-Pugh B（CP-B）肝硬化的背景下，对肝细胞癌（HCC）患者的治疗分配存在争议。已经提出了小范围的肝切除术，其结果令人满意，但数据有限。这项研究的目的是评估CP-B肝硬化中接受HCC肝切除的患者的结局，重点是手术风险和生存率。
方法

回顾性分析2002年至2017年从14个国际转诊中心收集的患者。对术后和肿瘤学结局进行了调查。建立了手术风险，无病生存期和总生存期的预测模型。
结果

总共包括253名患者，其中57.3％的患者术前血小板计数<100,000 / mm3，43.5％的患者术前腹水，56.9％的患者患有门脉高压。轻度肝切除最常见（84.6％），而122例（48.2％）通过微创手术（MIS）进行。 90天死亡率为4.3％，其中6名患者（2.3％）因肝衰竭而死。一百零八名患者（42.7％）经历了并发症，其中最常见的是腹水（37.5％）。接受大面积肝切除术的患者具有更高的90天死亡率（10.3％比3.3％； p = 0.04）和发病率（69.2％比37.9％； p <0.001）。接受开放性肝切除术的患者的发病率高于接受MIS的患者（52.7％vs. 31.9％； p = 0.001）。建立了手术风险的预测模型（https://childb.shinyapps.io/morbidity/）。 5年总生存率为47％，56.9％的患者复发。构建了总生存期（https://childb.shinyapps.io/survival/）和无病生存期（https://childb.shinyapps.io/DFsurvival/）的预测模型。
结论

对于肝癌和CP-B肝硬化患者，应根据患者的特征，肿瘤类型和肝功能进行仔细选择，并考虑将其切除，以最大程度地减少手术压力。评估手术风险和生存优势可能有助于分配治疗方案，最终改善术后发病率并实现安全的肿瘤学结果。
放置摘要

晚期肝硬化（Child-Pugh B评分）的肝癌肝切除术与术后并发症高发生率相关。但是，由于在这种情况下治疗方法的局限性，最近的研究表明，在准确选择患者后，结果令人鼓舞。在我们的国际多中心研究中，我们提供3种临床模型来预测肝切除术后的手术风险和长期存活率，目的是改善治疗分配并最终改善临床结果。
关键字：
肝细胞癌，肝切除，晚期肝硬化，Child-Pugh B