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Development and validation of risk score for predicting spontaneous rupture of hepatocellular carcinoma

Annals of Surgical Treatment and Research 2020년 99권 5호 p.268 ~ 274
Ye Feng, Ma Di, Gong Xiao-Yong, Yang Yu-Chen, Chen Yong-Jun,
소속 상세정보
 ( Ye Feng ) - Shanghai Jiaotong University School of Medicine Ruijin Hospital Department of General Surgery
 ( Ma Di ) - Shanghai Jiaotong University School of Medicine Ruijin Hospital Department of General Surgery
 ( Gong Xiao-Yong ) - Shanghai Jiaotong University School of Medicine Ruijin Hospital Department of General Surgery
 ( Yang Yu-Chen ) - Shanghai Jiaotong University School of Medicine Ruijin Hospital Department of General Surgery
 ( Chen Yong-Jun ) - Shanghai Jiaotong University School of Medicine Ruijin Hospital Department of General Surgery

Abstract


Purpose: Spontaneous rupture is a potentially serious complication of liver cancer. A risk score was developed and validated for predicting spontaneous rupture based on a retrospective study.

Methods: Multiple logistic regression analysis was used to study the relationship between clinical variables and spontaneous rupture. The independent rupture predictors were converted into a score based on the odds ratio. Predicted attributes of the developed scores were then verified using a dataset in 2019.

Results: The incidence of spontaneous rupture was 5.5% from 2002 to 2019. A 10-point score (α-FP of ≥400 μg/L, 1; protrusion from liver surface, 2; ascites, 3; tumor size of >5 cm, 4) was derived for prediction of rupture and area under the receiver-operating characteristic curve was 0.9 (95% confidence interval, 0.87?0.92). When applying a cutoff value of 5 points or more, the specificity was 0.87 and the sensitivity was 0.84. A validation cohort consisting of 202 hepatocellular carcinoma patients reproduces the predictive, identification, and calibration characteristics. The observed rate of spontaneous rupture according to risk stratification of the score was 0.6% for those with a score of 0?4, 21.6% for a score of 5?7, and 36.4% for a score of 8?10 in the validation cohort.

Conclusion: Here, based on routine clinical data, we determine the factors that affect prognosis and propose an effective tool for predicting spontaneous rupture, which may be useful in guiding priority treatment of high-risk patients or clinical routine preventive treatment.

키워드

Forecasting; Liver cancer; Patient recruitment; Rupture; Scoring methods

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