Independent factors and predictive score for extrahepatic metastasis of hepatocellular carcinoma following curative hepatectomy.
BACKGROUND
Postoperative extrahepatic metastasis (EHM) contributes to a poor prognosis in patients with hepatocellular carcinoma (HCC) after hepatectomy. This study was aimed to develop a practical method that can be used to predict postoperative EHM.


METHODS
In total, 578 patients were enrolled. We analyzed the clinicopathological features of the tumors and did a long-term follow-up to observe HCC recurrence. Postoperative EHM was detected in 136 patients, and multivariate analysis was used to confirm independent risk factors for postoperative EHM. After the factors were identified, a predictive scoring system was constructed as a weighted sum of these factors. The cutoff value that determines a high risk for EHM was defined by maximizing the Youden's index of the receiver operating characteristic curve.


RESULTS
Microvascular invasion, incomplete capsule, and larger tumor diameter were the three independent factors predictive for a high risk for EHM. The scoring system was derived with an area under the curve (AUC) of 0.81 for postoperative 10-year EHM prediction. A cutoff value of 43 was derived and validated with a sensitivity >90% and specificity >60% to predict the development of EHM. This system was further verified in a subgroup of Barcelona Clinic Liver Cancer stage 0-A patients with an AUC of 0.82. When the cutoff value was set at 43, the sensitivity and specificity were 90.38% and 64.88%, respectively.


CONCLUSIONS
Our predictive scoring system may be used to identify HCC patients who have a high risk for EHM following curative hepatectomy.
Department of Hepatic Surgery, Second Military Medical University, Shanghai, People's Republic of China.
Li
L
Jun
Yan
Y
Zhenlin
Gong
G
Renyan
Wang
W
Yizhou
Wan
W
Xuying
Xue
X
Feng
Xia
X
Yong
Wang
W
Kui
Liu
L
Jian
Wu
W
Dong
Wang
W
Hongyang
Shi
S
Lehua
Wu
W
Mengchao
Shen
S
Feng
D000293:Adolescent; D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D002648:Child; D015331:Cohort Studies; D005260:Female; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011379:Prognosis; D012307:Risk Factors; D055815:Young Adult