The complication-overall survival (CompOS) risk tool predicts risk of a severe postoperative complications relative to long-term survival among patients with primary liver cancer

Yutaka Endo; Diamantis I Tsilimigras; Selamawit Woldesenbet; Hugo P Marques; François Cauchy; Matthew Weiss; Todd W Bauer; George A Poultsides; Shishir K Maithel; Minoru Kitago; Sorin Alexandrescu; Guillaume Martel; Alfredo Guglielmi; Carlo Pulitano; Ana Gleisner; Tom Hugh; Luca Aldrighetti; Feng Shen; Bas G Koerkamp; Itaru Endo; Timothy M Pawlik

doi:10.1016/j.gassur.2023.12.010

The complication-overall survival (CompOS) risk tool predicts risk of a severe postoperative complications relative to long-term survival among patients with primary liver cancer

J Gastrointest Surg. 2024 Feb;28(2):132-140. doi: 10.1016/j.gassur.2023.12.010. Epub 2024 Feb 5.

Authors

Yutaka Endo¹, Diamantis I Tsilimigras¹, Selamawit Woldesenbet¹, Hugo P Marques², François Cauchy³, Matthew Weiss⁴, Todd W Bauer⁵, George A Poultsides⁶, Shishir K Maithel⁷, Minoru Kitago⁸, Sorin Alexandrescu⁹, Guillaume Martel¹⁰, Alfredo Guglielmi¹¹, Carlo Pulitano¹², Ana Gleisner¹³, Tom Hugh¹⁴, Luca Aldrighetti¹⁵, Feng Shen¹⁶, Bas G Koerkamp¹⁷, Itaru Endo¹⁸, Timothy M Pawlik¹⁹

Affiliations

¹ Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States.
² Department of Surgery, Hospital Curry Cabral, Lisbon, Portugal.
³ Department of Hepatobiliopancreatic Surgery, Assistance Publique-Hôpitaux de Paris, Beaujon Hospital, Clichy, France.
⁴ Department of Surgery, Northwell Health, New Hyde Park, New York, United States.
⁵ Department of Surgery, University of Virginia, Charlottesville, Virginia, United States.
⁶ Department of Surgery, Stanford University, Palo Alto, California, United States.
⁷ Department of Surgery, Emory University, Atlanta, Georgia, United States.
⁸ Department of Surgery, Keio University, Tokyo, Japan.
⁹ Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania.
¹⁰ Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada.
¹¹ Department of Surgery, University of Verona, Verona, Italy.
¹² Department of Surgery, Royal Prince Alfred Hospital, The University of Sydney, Sydney, New South Wales, Australia.
¹³ Department of Surgery, University of Colorado, Denver, Colorado, Unites States.
¹⁴ Department of Surgery, School of Medicine, The University of Sydney, Sydney, New South Wales, Australia.
¹⁵ Department of Surgery, Ospedale San Raffaele, Milan, Italy.
¹⁶ Department of Hepatic Surgery IV, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
¹⁷ Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
¹⁸ School of Medicine, Yokohama City University, Yokohama, Japan.
¹⁹ Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States. Electronic address: [email protected].

PMID: 38445934
DOI: 10.1016/j.gassur.2023.12.010

Abstract

Background: This study aimed to develop a tool based on preoperative factors to predict the risk of perioperative complications based on the Comprehensive Complication Index (CCI) and long-term survival outcomes after liver resection for primary liver cancer.

Methods: Patients with hepatocellular carcinoma (HCC) or intrahepatic cholangiocarcinoma (ICC) undergoing curative-intent hepatectomy between 1990 and 2020 were identified using a multi-institutional international database.

Results: Among 1411 patients who underwent curative-intent hepatic resection (HCC: 997, 70.7%; ICC: 414, 29.3%), median patient age was 66.0 years (IQR, 57.0-73.0), and most patients were male (n = 1001, 70.9%). In the postoperative setting, 699 patients (49.5%) experienced a complication; moreover, 112 patients (7.9%) had major complications. Although most patients had a favorable risk complication-overall survival (CompOS) profile (CCI score > 40 risk of <30% and median survival of >5 years: n = 778, 55.1%), 553 patients (39.2%) had an intermediate-risk profile, and 80 patients (5.7%) had a very unfavorable risk profile (CCI score > 40 risk of ≥30% and/or median survival of ≤1.5 years). The areas under the curve of the test and validation cohorts were 0.73 and 0.76, respectively.

Conclusion: The CompOS risk model accurately stratified patients relative to short- and long-term risks, identifying a subset of patients at a high risk of major complications and poor overall survival.

Keywords: Comprehensive Complication Index; Hepatocellular carcinoma; Intrahepatic cholangiocarcinoma; Multi-institutional database.

MeSH terms

Aged
Bile Duct Neoplasms* / surgery
Bile Ducts, Intrahepatic
Carcinoma, Hepatocellular* / surgery
Cholangiocarcinoma* / surgery
Female
Humans
Liver Neoplasms* / surgery
Male
Middle Aged
Postoperative Complications / epidemiology
Postoperative Complications / etiology