ObjectiveTo explore the influencing factors of textbook outcomes (TO) after radical resection for hepatic alveolar echinococcosis (HAE). MethodsClinical data from 427 patients diagnosed with HAE at the Ganzi Branch of West China Hospital, Sichuan University, between 2015 and 2022, were retrospectively collected. The least absolute shrinkage and selection operator regression (LASSO) was first used to screen potential influencing factors for achieving TO (predictive model A). Univariate and multivariate logistic regression analysis were then used to explore the influencing factors of TO (predictive model B). A Nomogram was further constructed and validated. ResultsA total of 427 patients who successfully underwent radical liver resection were included, of which 174 patients (40.7%) achieved TO. Compared to the non-TO group, patients in the TO group had higher proportions of WHO PNM stage of P 1+2 [62.6% (109/174) vs 42.3% (140/253)], N0 [77.0% (134/174) vs 63.6% (161/253)], lesion diameter≤10 cm [77.0% (134/174) vs 64.8% (164/253)], albumin-bilirubin index (ALBI) ≤–2.6 [70.1% (122/174) vs 59.3% (150/253)], and minor liver resection [71.8% (125/174) vs 50.2% (127/253)], higher prealbumin (181 mg/L vs 169 mg/L) and albumin (39 g/L vs 38 g/L) levels, shorter postoperative hospital stay (15 d vs 19 d), and lower hospitalization costs (51 727 RMB vs 62 715 RMB), P<0.05. LASSO regression analysis indicated that P stage, lesion diameter, ALBI, and liver resection method were potential influencing factors for achieving TO after HAE surgery (model A), P<0.05. The TO rate for P 1+2 stage was higher than that of P 3+4 stage, the TO rate for lesion diameter ≤ 10 cm was higher than that of lesion diameter >10 cm, the TO rate for ALBI ≤–2.6 was higher than that of ALBI >–2.6, and the TO rate for minor liver resection was higher than of major liver resection. Multivariate logistic regression analysis showed that P stage (OR=1.800, P=0.025) and liver resection method (OR=1.974, P<0.001) were influencing factors for achieving TO (model B). The TO rates for P1+2 stage and minor liver resection were higher. Predictive model A demonstrated higher accuracy and stability compared to predictive model B (AUC: 0.754 vs 0.712, C-index: 0.756 vs 0.707). ConclusionsAmong patients undergoing radical resection for HAE, less than half achieved TO. Striving to achieve TO can significantly shorten the length of hospital stay and effectively reduce medical costs. The TO predictive model based on P stage, lesion diameter, ALBI, and liver resection method is superior to the model based solely on P stage and liver resection method.
Objective To explore the impact of metabolic dysfunction-associated fatty liver disease (MAFLD) on the achievement of textbook outcome (TO) of patients with hepatocellular carcinoma (HCC) after hepatectomy, and to identify the risk factors affecting the achievement of TO of HCC patients after hepatectomy. MethodsThe data of patients with Barcelona Clinic Liver Cancer stage 0/A HCC who received primary hepatectomy at our center from 2014 to 2022 were retrospectively reviewed. Patients were divided into the MAFLD group and the non-MAFLD group based on whether coexisting MAFLD. Propensity score matching (PSM) was used to balance the baseline characteristics of the two groups. The achievement of TO and its seven items before and after PSM was compared between the two groups. Logistic regression was applied to analyze the independent risk factors affecting the achievement of TO based the total population. ResultsA total of 2 301 patients were included in this study. After PSM, 299 patients in each group were included in the analysis. After PSM, the TO achievement rate in the MAFLD group was 63.5% (190/299), which was significantly poor than that in the non-MAFLD group [71.6% (214/299)], χ2=4.395, P=0.036. Among the seven items of TO, the proportion of prolonged hospital stay in the MAFLD group was 29.4% (88/299), while that in the non-MAFLD group was 21.1% (63/299), the difference was statistically significant (χ2=5.537, P=0.019). The rates of ≥ Clavien-Dindo grade 3 complications within 30 days, perioperative blood transfusion, mortality within 90 days after surgery, readmission within 30 days after discharge, conversion from laparoscopic to open hepatectomy, and R0 resection rate were similar between the two groups (P>0.05). Multivariate logistic regression analysis confirmed that tumor diameter>5 cm [OR=1.539, 95%CI (1.264, 1.874), P<0.001], albumin-bilirubin grade 2 [OR=1.941, 95%CI (1.588, 2.372), P<0.001], FIB-4>3.25 [OR=1.545, 95%CI (1.273, 1.875), P<0.001], Barcelona Clinic Liver Cancer stage A [OR=1.696, 95%CI (1.132, 2.542), P=0.010], major hepatectomy [OR=1.431, 95%CI (1.178, 1.738), P<0.001], and MAFLD [OR=1.549, 95%CI (1.188, 2.019), P=0.001] were independent risk factors affecting the achievement of TO, but laparoscopic hepatectomy [OR=0.629, 95%CI (0.503, 0.786), P<0.001] was a protective factor for achieving TO. ConclusionHCC patients coexisting MAFLD have a higher incidence of prolonged hospital stay after hepatectomy and are less likely to achieve TO.