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Risk stratification model for predicting distant metastasis after hepatectomy for hepatocellular carcinoma: A multi-institutional analysis

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机构: [1]Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Naval Medical University), Shanghai, China [2]Eastern Hepatobiliary Clinical Research Institute, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Naval Medical University), Shanghai, China [3]Department of Graduate, Bengbu Medical College, Bengbu, China [4]The First Department of General Surgery, the Fourth Hospital of Harbin, Heilongjiang, China [5]Department of General Surgery, Liuyang People's Hospital, Hunan, China [6]Department of Hepatobiliary and Pancreatic Surgery, General Surgery Centre, First Hospital of Jilin University, Changchun, China [7]Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital, Fujian Medical University, Fujian, China [8]Department of Hepatobiliary Surgery, Pu'er People's Hospital, Yunnan, China [9]Department of General Surgery, First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong, China [10]Department of Hepatobiliary Surgery, Fuyang People's Hospital, Anhui, China [11]Department of General Surgery, Ziyang First People's Hospital, Sichuan, China [12]Department of Hepatobiliary Surgery, First Affiliated Hospital of Harbin Medical University, Heilongjiang, China.
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关键词: hepatocellular carcinoma hepatectomy distant metastasis survival recurrence

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Distant metastasis after hepatectomy for hepatocellular carcinoma (HCC) significantly impairs longterm outcome. This study aimed to identify patterns, risk factors, and develop a prediction model for distant metastasis at first recurrence following HCC resection. This multi-center retrospective study included patients undergoing curative hepatectomy for HCC. Risk factors for distant metastasis were identified using Cox regression. A nomogram was constructed and validated using the concordance index (C-index) and calibration curves. Among 2,705 patients, 1,507 experienced recurrence, with 342 (22.7 per cent) developing distant metastasis. Common metastatic sites included extrahepatic vessels (36.2 per cent), lungs (26.0 per cent), and lymph nodes (20.8 per cent). Patients with distant metastasis had significantly worse 5-year overall survival compared to those with intrahepatic recurrence (9.1 versus 41.1 per cent, p < 0.001). Independent risk factors included preoperative tumor rupture, tumor size over 5.0 cm, multiple tumors, satellite nodules, macro- and microvascular invasion, narrow resection margin, and intraoperative blood transfusion. The nomogram demonstrated excellent discrimination (C-index > 0.85) and accurately stratified patients into three risk categories. In conclusion, distant metastasis at first recurrence following HCC resection was associated with poor prognosis. The proposed nomogram facilitates accurate prediction of distant metastasis, potentially informing personalized postoperative monitoring and interventions for high-risk patients.

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大类 | 3 区 生物学
小类 | 3 区 生物学
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Q1 BIOLOGY

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第一作者机构: [1]Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Naval Medical University), Shanghai, China [2]Eastern Hepatobiliary Clinical Research Institute, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Naval Medical University), Shanghai, China
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通讯机构: [1]Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Naval Medical University), Shanghai, China [2]Eastern Hepatobiliary Clinical Research Institute, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Naval Medical University), Shanghai, China [3]Department of Graduate, Bengbu Medical College, Bengbu, China
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