Development models to predict complication and prognosis following liver resection for hepatocellular carcinoma in patients with clinically significant portal hypertension

Shilei Bai; Yizhe Dai; Pinghua Yang; Zhengqing Lei; Fuchen Liu; Zhao Yang; Fengwei Li; Yong Xia; Feng Shen; Kui Wang

doi:10.1016/j.amjsurg.2024.116172

Development models to predict complication and prognosis following liver resection for hepatocellular carcinoma in patients with clinically significant portal hypertension

Am J Surg. 2024 Dec 30:241:116172. doi: 10.1016/j.amjsurg.2024.116172. Online ahead of print.

Authors

Shilei Bai¹, Yizhe Dai², Pinghua Yang³, Zhengqing Lei⁴, Fuchen Liu⁵, Zhao Yang⁶, Fengwei Li⁷, Yong Xia⁸, Feng Shen⁹, Kui Wang¹⁰

Affiliations

¹ Department of Hepatic Surgery II, The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Naval Medical University), Shanghai, PR China. Electronic address: [email protected].
² Department of Hepatic Surgery IV, The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Naval Medical University), Shanghai, PR China. Electronic address: [email protected].
³ Department of Biliary Surgery IV, The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Naval Medical University), Shanghai, PR China. Electronic address: [email protected].
⁴ Department of Hepatobiliary Surgery, Zhongda Hospital, Southeast University, School of Medicine, Nanjing, Jiangsu, PR China. Electronic address: [email protected].
⁵ Department of Hepatic Surgery III, The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Naval Medical University), Shanghai, PR China. Electronic address: [email protected].
⁶ Department of Hepatic Surgery II, The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Naval Medical University), Shanghai, PR China. Electronic address: [email protected].
⁷ Department of Hepatic Surgery II, The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Naval Medical University), Shanghai, PR China. Electronic address: [email protected].
⁸ Department of Hepatic Surgery IV, The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Naval Medical University), Shanghai, PR China. Electronic address: [email protected].
⁹ Department of Hepatic Surgery IV, The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Naval Medical University), Shanghai, PR China. Electronic address: [email protected].
¹⁰ Department of Hepatic Surgery II, The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Naval Medical University), Shanghai, PR China. Electronic address: [email protected].

PMID: 39765145
DOI: 10.1016/j.amjsurg.2024.116172

Abstract

Background: Postoperative complications are potential factors influencing the prognosis of patients with HCC combined with CSPH. This study aims to explore the risk factors affecting the occurrence of postoperative complications, investigate potential factors influencing long-term prognosis in these patients, and establish predictive models.

Methods: From April 2018 to December 2021, a total of 190 patients with HCC combined with CSPH who underwent curative liver resection in our hospital were included, comprising 69 cases in the complication group and 121 cases in the non-complication group. LASSO-Logistic regression was employed to identify risk factors influencing postoperative complications and establish a predictive model. LASSO-Cox regression was used to determine prognostic factors for long-term outcomes in patients with HCC combined with CSPH and establish a predictive model.

Results: LASSO regression selected variables including ALBI grade, preoperative ascites, major hepatectomy, and portal vein occlusion time >15 min. These variables were incorporated into logistic regression (P < 0.05) to establish a nomogram for predicting postoperative complications, with a C-index of 0.723. Results from the multivariable Cox regression analysis showed that postoperative complications, maximum tumor diameter, and microvascular invasion were risk factors for recurrence, while postoperative complications, maximum tumor diameter, microvascular invasion, and prealbumin were risk factors for overall survival. The C-index values for the respective nomograms were 0.635 and 0.734. The calibration curves and ROC curves demonstrated good performance for all three nomograms.

Conclusions: The three nomograms achieved optimal predictive performance for postoperative complications, recurrence, and overall survival in patients with HCC combined with CSPH undergoing curative resection.

Keywords: Hepatocellular carcinoma; Nomogram; Portal vein hypertension; Postoperative complications; Prognosis.