Background: The incidence of deep vein thrombosis (DVT) in hepatocellular carcinoma (HCC) patients after laparoscopic hepatectomy (LH) is unclear, and there is no effective method for DVT risk assessment in these patients.
Methods: The data from the total of 355 consecutive HCC patients who underwent LH were included. A DVT risk algorithm was developed using a training set (TS) of 243 patients, and its predictive performance was evaluated in both the TS and a validation set (VS) of 112 patients. The model was then used to develop a DVT risk nomogram (TRN).
Results: The incidence of DVT in the present study was 18.6%. Age, sex, body mass index (BMI), comorbidities and operative position were independent risk factors for DVT in the TS. The model based on these factors had a good predictive ability. In the TS, it had an area under the receiver operating characteristic (AUC) curve of 0.861, Hosmer-Lemeshow (H-L) goodness of fit p value of 0.626, sensitivity of 44.4%, specificity of 96.5%, positive predictive value (PPV) of 74.1%, negative predictive value (NPV) of 88.4%, and accuracy of 86.8%. In the VS, it had an AUC of 0.818, H-L p value of 0.259, sensitivity of 38.1%, specificity of 98.9%, PPV of 88.9%, NPV of 87.4%, and accuracy of 87.5%. The TRN performed well in both the internal and the external validation, indicating a good clinical application value. The TRN had a better predictive value of DVT than the Caprini score (p < 0.001).
Conclusion: The incidence of DVT after LH was high, and should not be neglected in HCC patients. The TRN provides an efficacious method for DVT risk evaluation and individualized pharmacological thromboprophylaxis.



中文翻译：

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用于预测腹腔镜肝切除术后肝细胞癌患者深静脉血栓形成风险的列线图的构建和验证：一项回顾性研究

背景：肝细胞癌（HCC）患者腹腔镜肝切除术（LH）后深静脉血栓形成（DVT）的发生率尚不清楚，也没有有效的方法对这些患者进行深静脉血栓形成风险评估。
方法：纳入了总共 355 例接受 LH 的连续 HCC 患者的数据。使用 243 名患者的训练集 (TS) 开发了 DVT 风险算法，并在 TS 和 112 名患者的验证集 (VS) 中评估了其预测性能。然后将该模型用于开发 DVT 风险列线图 (TRN)。
结果：本研究中 DVT 的发生率为 18.6%。年龄、性别、体重指数（BMI）、合并症和手术位置是TS中DVT的独立危险因素。基于这些因素的模型具有良好的预测能力。在 TS 中，它的受试者工作特征 (AUC) 曲线下面积为 0.861，Hosmer-Lemeshow (HL) 拟合优度p值为 0.626，敏感性为 44.4%，特异性为 96.5%，阳性预测值 (PPV)为 74.1%，阴性预测值 (NPV) 为 88.4%，准确率为 86.8%。在 VS 中，它的 AUC 为 0.818，HL p值 0.259，灵敏度 38.1%，特异性 98.9%，PPV 88.9%，NPV 87.4%，准确度 87.5%。TRN在内部和外部验证中均表现良好，具有良好的临床应用价值。与 Caprini 评分相比，TRN 对 DVT 的预测价值更高（p < 0.001）。
结论： LH后DVT发生率较高，HCC患者不可忽视。TRN 为 DVT 风险评估和个体化药物血栓预防提供了一种有效的方法。