| 1 | Development of a machine learning model to predict early recurrence for hepatocellular carcinoma after curative resection显示文摘Background:Early recurrence is common for hepatocellular carcinoma(HCC)after surgical resection,being the leading cause of death.Traditionally,the COX proportional hazard(CPH)models based on linearity assumption have been used to predict early recurrence,but predictive performance is limited.Machine learning models offer a novel methodology and have several advantages over CPH models.Hence,the purpose of this study was to compare random survival forests(RSF)model with CPH models in prediction of early recurrence for HCC patients after curative resection.Methods:A total of 4,758 patients undergoing curative resection from two medical centers were included.Fifteen features including age,gender,etiology,platelet count,albumin,total bilirubin,AFP,tumor size,tumor number,microvascular invasion,macrovascular invasion,Edmondson-Steiner grade,tumor capsular,satellite nodules and liver cirrhosis were used to construct the RSF model in training cohort.Discrimination,calibration,clinical usefulness and overall performance were assessed and compared with other models.Results:Five hundred survival trees were used to generate the RFS model.The five highest Variable Importance(VIMP)were tumor size,macrovascular invasion,microvascular invasion,tumor number and AFP.In training,internal and external validation cohort,the C-index of RSF model were 0.725[standard errors(SE)=0.005],0.762(SE=0.011)and 0.747(SE=0.016),respectively;the Gönen&Heller’s K of RSF model were 0.684(SE=0.005),0.711(SE=0.008)and 0.697(SE=0.014),respectively;the time-dependent AUC(2 years)of RSF model were 0.818(SE=0.008),0.823(SE=0.014)and 0.785(SE=0.025),respectively.The RSF model outperformed early recurrence after surgery for liver tumor(ERASL)model,Korean model,American Joint Committee on Cancer tumor-node-metastasis(AJCC TNM)stage,Barcelona Clinic Liver Cancer(BCLC)stage and Chinese stage.The RSF model is capable of stratifying patients into three different risk groups(low-risk,intermediate-risk,high-risk groups)in the training and two validation cohorts(all P<0.0001).A web-based prediction tool was built to facilitate clinical application(http://gffzz8caf4f582aa3478es6owwbcc66fp569up.ffgz.tsg.suse.edu.cn/surgery_predict/).Conclusions:The RSF model is a reliable tool to predict early recurrence for patients with HCC after curative resection because it exhibited superior performance compared with other models.This novel model will be helpful to guide postoperative follow-up and adjuvant therapy. | Jianxing Zeng Jinhua Zeng Kongying Lin Haitao Lin Qionglan Wu Pengfei Guo Weiping Zhou Jingfeng Liu | 2022 | Hepatobiliary Surgery and Nutrition2022，11，2： | 6 |
| 2 | Impact of pathological response after preoperative transcatheter arterial chemoembolization(TACE)on incidences of microvascular invasion and early tumor recurrence in hepatocellular carcinoma:a multicenter propensity score matching analysis显示文摘Background:To study the influence of pathological responses(PR)after transcatheter arterial chemoembolization(TACE)on incidences of microvascular invasion(MVI)and early recurrence in hepatocellular carcinoma(HCC)patients.Methods:Between 2013 to 2015,consecutive HCC patients who underwent liver resection with“curative”intent at three hospitals were enrolled in this study.Patients with different areas of PR after preoperative TACE were compared with those without preoperative TACE on the incidences of MVI,early recurrence rates and patterns of recurrence before and after propensity score matching(PSM).Results:Of 1,970 patients,737 patients who received preoperative TACE were divided into three groups according to the areas of PR:≥90%(n=226),60-90%(n=447),and<60%(n=64).PR≥90%was an independent protective factor of incidences of MVI[odds ratio(OR),0.144;95%confidence interval(CI),0.082-0.245,P<0.001)and early recurrence(HR,0.742;95%CI,0.561-0.963,P=0.032);while PR<60%was an independent risk factor of incidences of MVI(OR,6.076;95%CI,3.004-11.728,P<0.001)and early recurrence(HR,1.428;95%CI,1.095-1.929;P=0.009).Furthermore,patients with PR<60%were significantly more likely to develop multiple intrahepatic recurrences involving multiple hepatic segments when compared with patients without preoperative TACE.Conclusions:This study indicated the area of PR after TACE was closely associated with the incidences of MVI and early tumor recurrence.Patients with PR<60%were at significantly higher risks of having more MVI,early and multiple tumor recurrences. | Yun Yang Zheng Dang Peng Lu Youwen Qian Kongying Lin Zeya Pan Wan Yee Lau Weiping Zhou | 2022 | Hepatobiliary Surgery and Nutrition2022，11，3： | 2 |
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