The pre- and postoperative nomograms to predict the textbook outcomes of patients who underwent hepatectomy for hepatocellular carcinoma

Gui-Lin Xie; Lei Liang; Tai-Wei Ye; Fei-Qi Xu; Dong-Dong Wang; Ya-Ming Xie; Kang-Jun Zhang; Tian-Wei Fu; Wei-Feng Yao; Jun-Wei Liu; Cheng-Wu Zhang

doi:10.3389/fonc.2023.1089716

The pre- and postoperative nomograms to predict the textbook outcomes of patients who underwent hepatectomy for hepatocellular carcinoma

Front Oncol. 2023 Apr 14:13:1089716. doi: 10.3389/fonc.2023.1089716. eCollection 2023.

Authors

Gui-Lin Xie¹, Lei Liang², Tai-Wei Ye^{2

3}, Fei-Qi Xu^{2

3}, Dong-Dong Wang², Ya-Ming Xie², Kang-Jun Zhang^{2

3}, Tian-Wei Fu^{2

3}, Wei-Feng Yao², Jun-Wei Liu², Cheng-Wu Zhang²

Affiliations

¹ Department of Hepatobiliary Surgery, Affiliated Hospital of Shaoxing University, Shaoxing, Zhejiang, China.
² General Surgery, Cancer Center, Department of Hepatobiliary and Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China.
³ The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China.

Abstract

Background and aims: An increasing number of studies have confirmed that non-textbook outcomes (non-TO) are a risk factor for the long-term outcome of malignant tumors. It is particularly important to identify the predictive factors of non-TO to improve the quality of surgical treatment. We attempted to construct two nomograms for preoperative and postoperative prediction of non-TO after laparoscopic hepatectomy for hepatocellular carcinoma (HCC).

Methods: Patients who underwent curative-intent hepatectomy for HCC between 2014 and 2021 at two Chinese hospitals were analyzed. Using univariate and multivariate analyses, the independent predictors of non-TO were identified. The prediction accuracy is accurately measured by the receiver operating characteristic (ROC) curve and calibration curve. ROC curves for the preoperative and postoperative models, Child-Pugh grade, BCLC staging, and 8th TNM staging were compared relative to predictive accuracy for non-TO.

Results: Among 515 patients, 286 patients (55.5%) did not achieve TO in the entire cohort. Seven and eight independent risk factors were included in the preoperative and postoperative predictive models by multivariate logistic regression analysis, respectively. The areas under the ROC curves for the postoperative and preoperative models, Child-Pugh grade, BCLC staging, and 8th TNM staging in predicting non-TO were 0.762, 0.698, 0.579, 0.569, and 0.567, respectively.

Conclusion: Our proposed preoperative and postoperative nomogram models were able to identify patients at high risk of non-TO following laparoscopic resection of HCC, which may guide clinicians to make individualized surgical decisions, improve postoperative survival, and plan adjuvant therapy against recurrence.

Keywords: hepatectomy; hepatocellular carcinoma; laparoscopic; nomogram; textbook outcomes.

Grants and funding

Funding for the study was provided by the Health Commission of Zhejiang Province (No. 2018KY261) and the General Scientific Research Project of the Education Department of Zhejiang Province (No. Y201840617). The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.