ObjectiveTo research the association between the prognostic nutritional index (PNI) and the prognosis of patients with malignant obstructive jaundice (MOJ) after interventional treatment. MethodsThe clinicopathologic data of patients with MOJ who were clinically diagnosed and underwent interventional treatment in the Affiliated Hospital of Southwest Medical University, from September 2018 to June 2021, were gathered retrospectively. The X-Tile statistical software was used to determine the optimal critical value of PNI before treatment, then the patients were allocated into the high PNI group (PNI was the optimal critical value or more) and low PNI group (PNI was less than the optimal critical value). The clinicopathologic characteristics of the two groups were compared. The Kaplan-Meier method was used to draw survival curve for survival analysis, and the Cox proportional hazards regression model was used to analyze the risk factors affecting the prognosis of patients with MOJ (the prognostic index was overall survival). ResultsA total of 205 patients were included in this study. The optimal critical value of PNI was 37.5. There were 154 cases in the high PNI group and 51 cases in the low PNI group, respectively. The proportions of the patients with biliary infection, CA19-9 ≥400 kU/L, hemoglobin <120 g/L, albumin <30 g/L, total bilirubin ≥300 μmol/L, and alanine aminotransferase <300 U/L were higher in the low PNI group as compared with the high PNI group (P<0.05). The median overall survival of patients in the high PNI group and low PNI group was 7.1 months and 3.6 months, respectively. The overall survival curve of the former was better than that the latter (χ2=18.514, P<0.001). The median follow-up time of 205 patients was 6.2 months, with a median overall survival of 5.3 months. The multivariate results of Cox proportional hazards regression model analysis showed that the probability of overall survival lengthening was increased for the patients with more times of PTCD, with stent implantation, with treatment for primary tumor, without metastasis, and with preoperative PNI ≥37.5 (P<0.05). ConclusionFrom the results of this study, preoperative peripheral blood PNI has a certain association with the prognosis of patients with MOJ after interventional treatment, and it is expected to be used to predict the prognosis of patients with MOJ in the future.
ObjectiveTo develop a nomogram prediction model for predicting the objective response rate (ORR) in patients with unresectable hepatocellular carcinoma (uHCC) receiving transarterial chemoembolization (TACE) combined with targeted therapy and immunotherapy. MethodsClinicopathological data of uHCC patients treated with TACE combined with targeted therapy and immunotherapy at Leshan People’s Hospital from January 2018 to November 2023 were collected. Patients were randomly divided into a training set and a validation set at a 7∶3 ratio. Univariate and multivariate logistic regression analyses were used to identify independent risk factors for ORR. Variables with P<0.05 in the multivariate analysis, together with clinically important factors [such as Eastern Cooperative Oncology Group performance status (ECOG PS) score and portal vein tumor thrombus (PVTT)], were incorporated into the nomogram model. Model performance and clinical utility were assessed using the area under the receiver operating characteristic curve (AUC), concordance index (C-index), calibration curves, and decision curve analysis. ResultsA total of 105 patients with uHCC were enrolled, including 73 in the training set and 32 in the validation set. Multivariate logistic regression analysis identified alpha-fetoprotein (AFP), Barcelona Clinic Liver Cancer (BCLC) stage, and prothrombin time (PT) as independent predictors of ORR (P<0.05). The nomogram incorporating these factors along with ECOG PS score and PVTT achieved AUCs (95%CI) of 0.81 (0.71, 0.91) in the training set and 0.80 (0.64, 0.96) in the validation set. Bootstrap internal validation (1 000 resamples) yielded a mean C-index (95%CI) of 0.76 (0.63, 0.89). The Hosmer-Lemeshow test indicated good model fit (training set: χ2=5.64, P=0.58; validation set: χ2=3.89, P=0.69), and calibration curves showed close alignment with the ideal diagonal in both sets. Decision curve analysis demonstrated positive net clinical benefit within threshold probability ranges of 0.02–0.78 (training set) and 0.10–0.80 (validation set). ConclusionThe nomogram prediction model based on AFP, BCLC stage, PT, ECOG PS score, and PVTT effectively predicts ORR in uHCC patients receiving TACE combined with targeted therapy and immunotherapy, providing a reference for individualized treatment decisions.
ObjectiveTo evaluate the safety and efficacy of extra-sheath dissection via the Laennec membrane space combined with indocyanine green (ICG) fluorescence navigation in laparoscopic anatomic hepatectomy. MethodsA retrospective analysis was conducted on the clinical data of hepatocellular carcinoma patients who underwent laparoscopic anatomic hepatectomy at Leshan People’s Hospital between January 2022 and September 2025. The study group comprised patients who underwent the extra-sheath anatomical approach via the Laennec’s capsule space combined with ICG fluorescence navigation, while the control group consisted of patients who underwent the conventional intra-sheath Glissonean pedicle transection approach combined with intraoperative ultrasound. ResultsA total of 113 patients were included in this study, including 54 cases in the study group and 59 cases in the control group. Intraoperative blood loss [MD=–139.88 mL, 95%CI (–229.51, –50.25) mL], number of drainage tubes × drainage tube indwelling time [MD=–2.00 (tubes×d), 95%CI (–4.00, 0.00) (tubes×d)], postoperative ambulation time [MD=–0.58 d, 95%CI (–0.94, –0.22) d], alanine aminotransferase level on postoperative day 1 [MD=–129.83 U/L, 95%CI (–259.96, –5.71) U/L], aspartate aminotransferase level on postoperative day 1 [MD=–131.09 U/L, 95%CI (–259.12, –3.06) U/L], albumin level on postoperative day 1 [MD=1.64 g/L, 95%CI (0.21, 3.06) g/L], and hospitalization cost [MD=–5 523.10 yuan, 95%CI (–10 572.42, –471.77) yuan] of the study group were all better than those in the control group (P< 0.05). ConclusionExtra-sheath dissection via the Laennec membrane space combined with ICG fluorescence navigation can improve the safety and efficacy of laparoscopic anatomical hepatectomy, and is worthy to explore further its clinical application value.
ObjectiveTo investigate the prognostic value of the alkaline phosphatase + gamma-glutamyl transpeptidase / platelet (AGPR) in predicting overall survival in patients with hepatocellular carcinoma (HCC) after curative hepatectomy, and to develop an AGPR-based nomogram prediction model to enhance the accuracy of prognostic risk stratification and individualized treatment decision-making. MethodsThis multicenter retrospective study included patients who underwent radical resection for HCC at the Affiliated Hospital of Southwest Medical University (2013–2023) as the training and internal validation sets, and at Leshan People’s Hospital (2018–2024) as the external validation set. Baseline characteristics, preoperative laboratory tests, surgical details, and pathological findings were collected. Optimal cutoff values for AGPR and the pan-immune-inflammation value (PIV) were determined using receiver operating characteristic (ROC) curves. Independent prognostic factors for overall survival were identified using univariate and multivariate Cox regression, then a nomogram was developed. Model performance was assessed using the area under the ROC curve (AUC), concordance index (C-index), calibration, and decision curve analysis for clinical utility assessment. Patients were stratified into low- and high-risk groups based on the median nomogram score, and overall survival was compared. ResultsA total of 618 patients were included: 250 in the training set, 167 in the internal validation set, and 201 in the external validation set. Optimal cutoff values were 1.06 for AGPR and 316.79 for PIV. Multivariate Cox regression identified alpha-fetoprotein (AFP), AGPR, PIV, and tumor diameter as independent prognostic factors (P＜0.05). The nomogram predicting 1-, 3-, and 5-year overall survival rates achieved AUCs of 0.820, 0.734, and 0.727 in the training set; 0.784, 0.722, and 0.705 in the internal validation set; and 0.789, 0.703, and 0.702 in the external validation set. C-indices were 0.748, 0.701, and 0.692, respectively. The Hosmer-Lemeshow test indicated good calibration (P>0.05), and calibration curves aligned closely with the ideal diagonal. Decision curve analysis demonstrated clinical net benefit across all datasets. Low-risk patients had significantly better overall survival than high-risk patients (P＜0.05). ConclusionsAGPR is an independent prognostic factor for overall survival in HCC patients after radical resection. The nomogram incorporating AGPR, AFP, PIV, and tumor diameter exhibits favorable discrimination, calibration, and clinical utility, supporting its use for postoperative risk stratification and individualized treatment planning.