Background

It has previously been demonstrated that a fraction of patients with hepatocellular carcinoma (HCC) >10 cm can benefit from liver resection. However, there is still a lack of effective decision-making tools to inform intervention in these patients.

Methods

We analysed a comprehensive set of clinical data from 234 patients who underwent liver resection for HCC >10 cm at the National Cancer Institute of Peru between 1990 and 2015, monitored their survival, and constructed a nomogram to predict the surgical outcome based on preoperative variables.

Results

We identified cirrhosis, multifocality, macroscopic vascular invasion, and spontaneous tumour rupture as independent predictors of survival and integrated them into a nomogram model. The nomogram's ability to forecast survival at 1, 3, and 5 years was subsequently confirmed with high concordance using an internal validation. Through applying this nomogram, we stratified three groups of patients with different survival probabilities.

Conclusion

We constructed a nomogram to predict long-term survival in patients with HCC >10 cm. This nomogram is useful in determining whether a patient with large HCC might truly benefit from liver resection, which is paramount in low- and middle-income countries where HCC is often diagnosed at advanced stages.

中文翻译：

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预测大型肝细胞癌（>10 cm）切除术后长期生存的术前列线图

背景

先前已经证明，一小部分肝细胞癌 (HCC) > 10 cm 的患者可以从肝切除术中受益。然而，仍然缺乏有效的决策工具来为这些患者的干预提供信息。

方法

我们分析了 1990 年至 2015 年间在秘鲁国家癌症研究所接受肝切除术 > 10 cm 的 234 名患者的一组综合临床数据，监测他们的生存情况，并构建了一个基于术前变量预测手术结果的列线图。

结果

我们将肝硬化、多灶性、肉眼可见的血管侵犯和自发性肿瘤破裂确定为生存的独立预测因子，并将它们整合到列线图模型中。列线图预测 1 年、3 年和 5 年生存率的能力随后通过内部验证得到高度一致的证实。通过应用这个列线图，我们对具有不同生存概率的三组患者进行了分层。

结论

我们构建了一个列线图来预测 HCC > 10 cm 患者的长期生存率。该列线图有助于确定患有大 HCC 的患者是否真正受益于肝切除术，这在 HCC 通常在晚期被诊断出的低收入和中等收入国家至关重要。