Prognostic model for identifying candidates for hepatectomy among patients with hepatocellular carcinoma and hepatic vein invasion

Abstract

Background: Hepatic vein tumour thrombus (HVTT) is a major determinant of survival outcomes for patients with hepatocellular carcinoma (HCC). An Eastern Hepatobiliary Surgery Hospital (EHBH)-HVTT model was established to predict the prognosis of patients with HCC and HVTT after liver resection, in order to identify optimal candidates for liver resection. Methods: Patients with HCC and HVTT from 15 hospitals in China were included. The EHBH-HVTT model with contour plot was developed using a non-linear model in the training cohort, and subsequently validated in internal and external cohorts.Results: Of 850 patients who met the inclusion criteria, there were 292 patients who had liver resection and 198 who did not in the training cohort, and 124 and 236 in the internal and external validation cohorts respectively. Contour plots for the EHBH-HVTT model were established to predict overall survival (OS) rates of patients visually, based on tumour diameter, number of tumours and portal vein tumour thrombus. This differentiated patients into low-and high-risk groups with distinct long-term prognoses in the liver resection cohort (median OS 34⋅7 versus 12⋅0 months; P < 0⋅001), internal validation cohort (32⋅8 versus 10⋅4 months; P = 0⋅002) and external validation cohort (15⋅2 versus 6⋅5 months; P = 0⋅006). On subgroup analysis, the model showed the same efficacy in differentiating patients with HVTT in peripheral and major hepatic veins, the inferior vena cava, or in patients with coexisting portal vein tumour thrombus. Conclusion:The EHBH-HVTT model was accurate in predicting prognosis in patients with HCC and HVTT after liver resection. It identified optimal candidates for liver resection among patients with HCC and HVTT, including tumour thrombus in the inferior vena cava, or coexisting portal vein tumour thrombus.

The Recent Development of the Surgical Treatment for Hepatocellular Carcinoma

“…On the other hand, PVTT was an independent poor prognostic factor in the p/mHVTT resection group, and the MST of patients with PVTT was 45.4 months shorter than the patients without PVTT (22.6 months vs. 68 months). Similar reports have been reported from Asian countries, and therefore they recommended that at least HCC patients with intrahepatic HVTT without PVTT could be suitable for liver resection [42][43][44]. For preventing intrahepatic recurrence, the usefulness of postoperative adjuvant TACE has been reported, and further evaluation with randomized trials are warranted [45].…”

TIPS improves outcomes in patients with HCC and symptomatic portal hypertension: a multi-institution experience

“…AFP is an independent prognostic factor, and the prognostic factors identified are similar to those identified in previous studies. We showed that the prognosis of HCC with SPH was determined by multiple factors, including tumor burden [ 15 , 28 – 30 ].…”

Development of preoperative and postoperative machine learning models to predict the recurrence of huge hepatocellular carcinoma following surgical resection

“…The preoperative and postoperative RSF model was established based on the preoperative clinical imaging data and the clinicopathological variables, respectively. The predictive performance of the RSF model was measured using Harrell's concordance index (C-index), the time-dependent areas under the receiver operating characteristic curve (tdAUC), the prediction error curve, and the calibration plot (21,22). Clinical usefulness was measured by decision curve analysis (DCA) with a net benefit at a threshold of 50%.…”