Performance of Comprehensive Complication Index and Clavien-Dindo Complication Scoring System in Liver Surgery for Hepatocellular Carcinoma
Abstract
:Simple Summary
Abstract
1. Introduction
2. Material and Methods
2.1. Study Overview and Population
2.2. Variables and Definitions
2.3. Endpoints
2.4. Statistical Analysis
3. Results
3.1. Descriptive Findings
3.2. Association of CCI and CDC with Postoperative LOS and e-LOS
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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Variables | Derivation Set (N = 1345) | Validation Set (N = 1324) | ||
---|---|---|---|---|
Median [IQR] or n (%) | Missing (%) | Median [IQR] or n (%) | Missing (%) | |
Age | 70.0 [63.0, 75.0] | 1.2 | 69.8 [62.4, 75.1] | 0.7 |
Females | 328 (24.4) | 0 | 271 (20.5) | 0 |
American Society of Anesthesiologists score | 2.7 | 4.7 | ||
1 | 16 (1.2) | 50 (4.0) | ||
2 | 682 (52.1) | 550 (43.6) | ||
≥3 | 611 (46.7) | 662 (52.5) | ||
Cirrhosis | 927 (70.5) | 2.3 | 741 (56.1) | 0.2 |
Child-Pugh Grade | 3.9 | 0 | ||
A | 1175 (90.9) | 1294 (97.1) | ||
B | 118 (9.1) | 30 (2.3) | ||
Surgery duration, min | 230 [170, 290] | 2.3 | 270 [200, 370] | 3.8 |
Blood transfusion during surgery | 118 (9.1) | 3.3 | 181 (14.5) | 6.0 |
Laparoscopy | 568 (42.2) | 0 | 268 (21.4) | 5.5 |
Clavien-Dindo grading | 0 | 0 | ||
0 | 894 (66.5) | 789 (59.6) | ||
I | 101 (7.5) | 155 (11.7) | ||
II | 255 (19.0) | 236 (17.8) | ||
IIIa | 40 (3.0) | 71 (5.4) | ||
IIIb | 17 (1.3) | 31 (2.3) | ||
IVa | 20 (1.5) | 18 (1.4) | ||
IVb | 4 (0.3) | 4 (0.3) | ||
V | 14 (1.0) | 20 (1.5) | ||
Comprehensive Complication Index CCI > 0 | 20.9 [20.9, 26.6] | 0 | 20.9 [8.7, 29.6] | 0 |
Length of hospitalization, days | 7.0 [5.0, 9.0] | 0 | 9.0 [7.0, 12.0] | 0 |
HBV | 276 (21.4) | 4.0 | 213 (16.2) | 0.5 |
HCV | 714 (55.3) | 4.1 | 544 (41.3) | 0.4 |
Bilirubin, mg/dL | 0.90 [0.63, 1.23] | 1.8 | 0.80 [0.60, 1.01] | 1.4 |
Albumin, g/dL | 3.80 [3.50, 4.21] | 3.4 | 4.00 [3.80, 4.30] | 2.7 |
Platelets, 10^3/mm3 | 169.0 [117.0, 230.0] | 1.8 | 170.0 [123.0, 223.8] | 0.5 |
International Normalized Ratio | 1.12 [1.03, 1.29] | 1.9 | 1.08 [1.02, 1.15] | 1.3 |
Number of nodules | 0.1 | 3.9 | ||
1 | 1068 (79.5) | 973 (76.4) | ||
2 | 202 (15.0) | 186 (14.6) | ||
3 | 56 (4.2) | 71 (5.6) | ||
4 | 12 (0.9) | 25 (2.0) | ||
5 | 5 (0.4) | 5 (0.4) | ||
≥6 | 1 (0.1) | 13 (1.0) | ||
Size of bigger nodule, cm | 4.0 [2.9, 6.0] | 0.4 | 4.0 [2.5, 6.3] | 1.9 |
Major surgery | 293 (21.8) | 0.3 | 263 (20.1) | 1.1 |
Surgical procedure | 0.5 | 0.2 | ||
Parenchyma-sparing resection | 400 (29.9) | 579 (43.8) | ||
Segmentecnomy | 437 (32.6) | 325 (24.6) | ||
Right hepatectomy | 129 (9.6) | 115 (8.7) | ||
Left hepatectomy | 106 (7.9) | 81 (6.1) | ||
Right posterior sectionectomy | 32 (2.4) | 19 (1.4) | ||
Right anterior sectionectomy | 58 (4.3) | 32 (2.4) | ||
Left lateral sectionectomy | 85 (6.3) | 52 (3.9) | ||
Right trisectionectomy | 13 (1.0) | 14 (1.1) | ||
Left trisectionectomy | 6 (0.4) | 1 (0.1) | ||
Other | 72 (5.4) | 104 (7.9) | ||
Number of complications | 0 | 0 | ||
0 | 894 (66.5) | 787 (59.4) | ||
1 | 260 (19.3) | 363 (27.4) | ||
≥2 | 191 (14.2) | 174 (13.1) | ||
Center volume | 0 | 0 | ||
Low | 108 (8.0) | 113 (8.5) | ||
Medium | 608 (45.2) | 180 (13.6) | ||
High | 629 (46.8) | 1031 (77.9) |
Sample | Model | Derivation Set | Validation Set | |||
---|---|---|---|---|---|---|
Mean Change (95% CI) | R2 | RMSE | R2 | RMSE | ||
Overall sample Derivation set n = 1331. Validation set n = 1304. | CCI, per 10 unit increase Univariate model | 0.290 (0.273;0.307) | 45% | 0.41 | 36% | 0.49 |
Clavien-Dindo, per category increase Univariate model | 0.312 (0.292;0.332) | 41% | 0.43 | 34% | 0.49 | |
CCI, per 10 unit increase Multivariate model | 0.267 (0.251;0.282) | 57% | 0.37 | 44% | 0.50 | |
Clavien-Dindo, per category increase Multivariate model | 0.291 (0.273;0.309) | 54% | 0.38 | 43% | 0.51 | |
Subgroup of patients with at least two complications Derivation set n = 177. Validation set n = 154. | CCI, per 10 unit increase Univariate model | 0.240 (0.197;0.283) | 41% | 0.47 | 15% | 0.59 |
Clavien-Dindo, per category increase Univariate model | 0.254 (0.186;0.323) | 24% | 0.54 | 12% | 0.59 | |
CCI, per 10 unit increase Multivariate model | 0.219 (0.176;0.262) | 47% | 0.45 | 23% | 0.59 | |
Clavien-Dindo, per category increase Multivariate model | 0.223 (0.157;0.289) | 32% | 0.52 | 21% | 0.63 |
Sample | Model | Derivation Set | Validation Set | |
---|---|---|---|---|
OR (95% CI) | AUC | AUC | ||
Overall sample Derivation set n = 1331. Validation set n = 1304. | CCI, per 10 unit increase Univariate model | 5.826 (4.402;7.709) | 96.1% | 87.7% |
Clavien-Dindo, per category increase Univariate model | 5.298 (4.067;6.902) | 94.0% | 86.9% | |
CCI, per 10 unit increase Multivariate model | 5.590 (4.201;7.438) | 96.4% | 89.3% | |
Clavien-Dindo, per category increase Multivariate model | 5.507 (4.152;7.304) | 96.2% | 89.0% | |
Subgroup of patients with at least two complications Derivation set n = 177. Validation set n = 154. | CCI, per 10 unit increase Univariate model | 3.003 (2.085;4.327) | 83.0% | 67.1% |
Clavien-Dindo, per category increase Univariate model | 2.638 (1.794;3.878) | 76.5% | 65.2% | |
CCI, per 10 unit increase Multivariate model | 2.793 (1.896;4.115) | 85.0% | 67.3% | |
Clavien-Dindo, per category increase Multivariate model | 2.439 (1.666;3.57) | 80.6% | 65.8% |
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Giani, A.; Cipriani, F.; Famularo, S.; Donadon, M.; Bernasconi, D.P.; Ardito, F.; Fazio, F.; Nicolini, D.; Perri, P.; Giuffrida, M.; et al. Performance of Comprehensive Complication Index and Clavien-Dindo Complication Scoring System in Liver Surgery for Hepatocellular Carcinoma. Cancers 2020, 12, 3868. https://doi.org/10.3390/cancers12123868
Giani A, Cipriani F, Famularo S, Donadon M, Bernasconi DP, Ardito F, Fazio F, Nicolini D, Perri P, Giuffrida M, et al. Performance of Comprehensive Complication Index and Clavien-Dindo Complication Scoring System in Liver Surgery for Hepatocellular Carcinoma. Cancers. 2020; 12(12):3868. https://doi.org/10.3390/cancers12123868
Chicago/Turabian StyleGiani, Alessandro, Federica Cipriani, Simone Famularo, Matteo Donadon, Davide Paolo Bernasconi, Francesco Ardito, Federico Fazio, Daniele Nicolini, Pasquale Perri, Mario Giuffrida, and et al. 2020. "Performance of Comprehensive Complication Index and Clavien-Dindo Complication Scoring System in Liver Surgery for Hepatocellular Carcinoma" Cancers 12, no. 12: 3868. https://doi.org/10.3390/cancers12123868
APA StyleGiani, A., Cipriani, F., Famularo, S., Donadon, M., Bernasconi, D. P., Ardito, F., Fazio, F., Nicolini, D., Perri, P., Giuffrida, M., Pontarolo, N., Zanello, M., Lai, Q., Conci, S., Molfino, S., Germani, P., Pinotti, E., Romano, M., La Barba, G., ... Gianotti, L. (2020). Performance of Comprehensive Complication Index and Clavien-Dindo Complication Scoring System in Liver Surgery for Hepatocellular Carcinoma. Cancers, 12(12), 3868. https://doi.org/10.3390/cancers12123868