Abstract
Simple SummaryHepatocellular carcinoma (HCC) is a major malignancy correlated with many cancer-related deaths. Surgical intervention provides superior long-term survival; however, perioperative mortality is a major concern for clinicians while making treatment decisions, especially for major hepatectomy. Scoring systems for predicting 90-day mortality in patients with HCC undergoing major hepatectomy are not available. By using the stepwise selection of the multivariate Cox proportional hazards model, we divided the patients with HCC receiving major hepatectomy into four risk groups. The Chang Gung-PohAi predictive scoring system showed significant differences in the 90-day mortality rate among the four risk groups (very low risk: 2.42%, low risk: 4.09%, intermittent risk: 17.1%, and high risk 43.6%). The Chang Gung-PohAi predictive scoring system is a promising tool for predicting 90-day perioperative mortality in patients with HCC undergoing major hepatectomy.Purpose: Hepatocellular carcinoma (HCC) is a major malignancy and the common cause of cancer-related deaths. Surgical intervention provides superior long-term survival outcomes; however, perioperative mortality is a major concern for clinicians while making treatment decisions, especially for major hepatectomy. Scoring systems for predicting 90-day mortality in patients with HCC undergoing major hepatectomy are not available. Methods: This study used the Taiwan Cancer Registry Database that is linked to the National Health Insurance Research Database to analyze data of 60,250 patients with HCC who underwent major hepatectomy and determine risk factors to establish a novel predictive scoring system. By using the stepwise selection of the multivariate Cox proportional hazards model, we divided the patients with HCC undergoing major hepatectomy into four risk groups. Results: The Chang Gung-PohAi predictive scoring system exhibited significant differences in the 90-day mortality rate among the four risk groups (very low risk: 2.42%, low risk: 4.09%, intermittent risk: 17.1%, and high risk: 43.6%). Conclusion: The Chang Gung-PohAi predictive scoring system is a promising tool for predicting 90-day perioperative mortality in patients with HCC undergoing major hepatectomy.
Highlights
Hepatocellular carcinoma (HCC) is the leading primary malignancy of the liver [1,2].HCC is the seventh most frequently occurring cancer globally and the second most common cause of cancer mortality [1,2]
Of the 60,250 patients enrolled in this study, 2725 (1840 [67%] men; mean [standard deviation, SD] age, 61.61 [16.43] years) died before reaching the 90-day threshold, whereas 57,525 patients (36,666 [63.7%] men; mean [SD] age, 58.39 [13.72] years) survived for more than 90 days
We examined whether our scoring system can predict long-term survival
Summary
HCC is the seventh most frequently occurring cancer globally and the second most common cause of cancer mortality [1,2]. The incidence rate of HCC is considerably high in Asia and sub-Saharan Africa [3]. The prognosis of HCC is unsatisfactory in all regions of the world, surgical intervention provides favorable outcomes in the very early (Barcelona Clinic Liver Cancer [BCLC] 0) and early (BCLC A) stages of HCC [6]. A study reported that patients beyond the early stage (BCLC stage B) could benefit from liver resection [7]. In the 1980s, liver resection resulted in a relatively high mortality rate, ranging from 10% to 30%, and was limited to minor resection [8]. With improvements in patient selection by using the indocyanine green (ICG) test [9], surgical techniques [10], equipment used for parenchymal transection, [11] and postoperative care, the short-term (30-day) mortality rate has substantially improved (
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