Construction Of Risk Prediction Model For Postoperative Complications Of Hepatocellular Carcinoma

Objective:To explore the risk factors of post-hepatectomy complications in patients with hepatocellular carcinoma(HCC),and to establish a visual line graph model with predictive value on this basis,providing reference for the prevention of postoperative complications in HCC patients and the selection of diagnosis and treatment strategies.Methods:The clinical data of 159 patients with HCC who underwent hepatectomy in the Department of hepatobiliary surgery of the Affiliated Hospital of Guizhou Medical University from January 2016 to December 2020 were analyzed retrospectively.The postoperative complications were graded by Dindo demartines Clavien grading system,and the complications ≥ grade II were classified as clinically significant complications.The independent risk factors related to postoperative complications of HCC were selected by univariate analysis and multivariate logistic regression analysis,and the nomogram model for predicting the risk of postoperative complications of HCC was constructed by R software.The model was internally validated by the Bootstrap self-sampling method,and the area under the curve(AUC),the concordance index(C-index),the receiver operating characteristic(ROC)curve,and the The calibration curve and Hosmer-Lemeshow goodness-of-fit test were used to verify the calibration and discrimination of the model,and clinical decision curve analysis(DCA)was used to evaluate the clinical application value of the model.Results:According to Dindo demartines Clavien grading system,a total of 30 patients(18.9%)had postoperative complications ≥ grade II.Univariate analysis showed that body mass index(BMI),preoperative hemoglobin(hemoglobin,Hb),preoperative albumin(albumin,Alb),cirrhosis,diabetes,surgical procedures,precise hepatectomy,operative time,intraoperative blood loss,intraoperative blood transfusion and transfusion volume were related factors of postoperative complications in HCC patients.The results of multivariate logistic regression analysis showed that BMI,liver cirrhosis,operation mode,precise hepatectomy,operation time and intraoperative bleeding were independent risk factors for postoperative complications in patients with HCC.A nomogram model for predicting the risk of postoperative complications of HCC was constructed based on the above six indicators.The AUC of the prediction model is 0.85(95% CI = 0.764 ～ 0.936).Bootstrap self sampling method is internally verified,and the c-index is 0.82,suggesting that the discrimination of the model is good.The calibration curve is close to the ideal standard line,and the p value of Hosmer lemeshow goodness of fit test is 0.379,indicating that the calibration degree of the model is good.DCA showed that the clinical benefit of nomogram was higher than that of single risk factors.Conclusions:BMI,liver cirrhosis,operation method,precise hepatectomy,operation time and intraoperative bleeding are independent risk factors affecting the occurrence of postoperative complications in patients with HCC.The nomogram model based on these six indicators has good prediction ability and clinical application value for the risk of postoperative complications of HCC,and can provide reference basis for the treatment of HCC.