■我们旨在调查肝细胞癌(HCC)患者术后早期复发的危险因素,并确定手术方法对早期复发的影响,以预测此类患者术后早期复发的风险并选择适当的治疗方法。
■我们回顾性分析了2015年1月至2022年8月在绵阳市中心医院接受根治性手术的428例HCC患者的临床资料。术前相关常规辅助检查及术后定期电话或门诊随访,明确术后早期复发。风险因素进行了筛查,并构建了预测模型,包括患者术前辅助检查,术中和术后并发症,和病理检查与早期复发有关。根据预测模型估计每位患者的复发风险,将患者分为低危和高危复发组.使用生存分析评估了解剖性肝切除术(AR)对两组HCC患者术后早期复发的影响。
■总共,纳入353名研究患者。多因素logistic回归分析结果表明,肿瘤直径(≥5/<5cm,优势比[OR]2.357,95%置信区间[CI]1.368-4.059;P=0.002),甲胎蛋白(≥400/<400ng/L,OR2.525,95%CI1.334-4.780;P=0.004),肿瘤数量(≥2/<2,OR2.213,95%CI1.147-4.270;P=0.018),微血管侵犯(阳性/阴性,OR3.230,95%CI1.880-5.551;P<0.001),血管侵犯(阳性/阴性,OR4.472,95%CI1.395-14.332;P=0.012),和碱性磷酸酶水平(>125/≤125U/L,OR2.202,95%CI1.162-4.173;P=0.016)是肝癌根治术后早期复发的危险因素。模型验证和评价显示,曲线下面积为0.813。Hosmer-Lemeshow试验结果(X2=1.225,P=0.996>0.05),自举自我复制采样1000个样本的结果,和决策曲线分析表明,该模型也有很好的判别,具有潜在的良好临床效用。使用这个模型,患者被分为低危和高危复发组.比较两组采用不同手术方式的一年无病生存率。两组在预防术后早期复发方面均受益于AR,在高危复发组中,AR获益更为明显,术中出血的可能性较小。
■通过适当的手术技术和肿瘤可以进行R0切除,AR是预防HCC患者根治性手术后早期复发的潜在有用外科手术。
UNASSIGNED: We aimed to investigate risk factors for early postoperative recurrence in patients with
hepatocellular carcinoma (HCC) and determine the effect of surgical methods on early recurrence to facilitate predicting the risk of early postoperative recurrence in such patients and the selection of appropriate treatment methods.
UNASSIGNED: We retrospectively analyzed clinical data concerning 428 patients with HCC who had undergone radical surgery at Mianyang Central Hospital between January 2015 and August 2022. Relevant routine preoperative auxiliary examinations and regular postoperative telephone or outpatient follow-ups were performed to identify early postoperative recurrence. Risk factors were screened, and predictive models were constructed, including patients\' preoperative ancillary tests, intra- and postoperative complications, and pathology tests in relation to early recurrence. The risk of recurrence was estimated for each patient based on a prediction model, and patients were categorized into low- and high-risk recurrence groups. The effect of anatomical liver resection (AR) on early postoperative recurrence in patients with HCC in the two groups was assessed using survival analysis.
UNASSIGNED: In total, 353 study patients were included. Multifactorial logistic regression analysis findings suggested that tumor diameter (≥5/<5 cm, odds ratio [OR] 2.357, 95% confidence interval [CI] 1.368-4.059; P = 0.002), alpha fetoprotein (≥400/<400 ng/L, OR 2.525, 95% CI 1.334-4.780; P = 0.004), tumor number (≥2/<2, OR 2.213, 95% CI 1.147-4.270; P = 0.018), microvascular invasion (positive/negative, OR 3.230, 95% CI 1.880-5.551; P < 0.001), vascular invasion (positive/negative, OR 4.472, 95% CI 1.395-14.332; P = 0.012), and alkaline phosphatase level (>125/≤125 U/L, OR 2.202, 95% CI 1.162-4.173; P = 0.016) were risk factors for early recurrence following radical HCC surgery. Model validation and evaluation showed that the area under the curve was 0.813. Hosmer-Lemeshow test results (X 2 = 1.225, P = 0.996 > 0.05), results from bootstrap self-replicated sampling of 1,000 samples, and decision curve analysis showed that the model also discriminated well, with potentially good clinical utility. Using this model, patients were stratified into low- and high-risk recurrence groups. One-year disease-free survival was compared between the two groups with different surgical approaches. Both groups benefited from AR in terms of prevention of early postoperative recurrence, with AR benefits being more pronounced and intraoperative bleeding less likely in the high-risk recurrence group.
UNASSIGNED: With appropriate surgical techniques and with tumors being realistically amenable to R0 resection, AR is a potentially useful surgical procedure for preventing early recurrence after radical surgery in patients with HCC.