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已发表论文
腹腔镜肝细胞癌切除术教材成果达成影响因素分析及诺模图模型的建立
Authors Qiu J, Pei H, Shen Q, Wang J, Jiang X, Zhu J, Zhou X, Yang X, Xie H
Received 14 August 2025
Accepted for publication 24 October 2025
Published 8 January 2026 Volume 2026:13 555719
DOI https://doi.org/10.2147/JHC.S555719
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Mohamed Shaker
Jingxia Qiu,1 Hualian Pei,2 Qiongxi Shen,1 Jingjing Wang,1 Ximing Jiang,3 Jiyun Zhu,1 Xiaoqian Zhou,1 Xiaoping Yang,1 Haofen Xie4
1Hepatobiliary Surgery, The First Affiliated Hospital of Ningbo University, Ningbo City, Zhejiang Province, 315020, People’s Republic of China; 2Nursing Department, The First Affiliated Hospital of Ningbo, Ningbo City, Zhejiang Province, 315020, People’s Republic of China; 3The Medical Engineering Department, The First Affiliated Hospital of Ningbo University, Ningbo City, Zhejiang Province, 315020, People’s Republic of China; 4Outpatient Department, The First Affiliated Hospital of Ningbo University, Ningbo City, Zhejiang Province, 315020, People’s Republic of China
Correspondence: Haofen Xie, Outpatient Department, The First Affiliated Hospital of Ningbo University, No. 247 Renmin Road, Jiangbei District, Ningbo City, Zhejiang Province, 315020, People’s Republic of China, Tel +86 13867889859, Email xihfff2022@126.com Xiaoping Yang, Hepatobiliary Surgery, the First Affiliated Hospital of Ningbo University, No. 247 Renmin Road, Jiangbei District, Ningbo City, Zhejiang Province, 315020, People’s Republic of China, Email yangxiaoping_56@21cn.com
Objective: To analyse the influencing factors for textbook outcome (TO) achievement in laparoscopic hepatectomy for hepatocellular carcinoma (HCC) and to construct and validate a nomogram model.
Methods: A total of 200 patients with HCC who underwent laparoscopic hepatectomy in our hospital between January 2022 and December 2024 were retrospectively analysed and divided into a TO group (n = 116) and a non-TO group (n = 84) according to the TO in liver surgery criteria. Twenty clinical parameters were collected, and after univariate analysis to screen variables, multivariate logistic regression was performed to determine independent influencing factors and establish nomograms. Model discrimination, calibration and clinical benefit were assessed using receiver operating characteristic (ROC) curves, calibration curves and decision curves.
Results: Multivariate logistic analysis showed that no malnutrition before operation (odds ratio [OR] = 0.051; 95% confidence interval [CI]: 0.014– 0.179), intraoperative blood loss < 225 mL (OR = 0.096; 95% CI: 0.030– 0.310) and postoperative hospital stay < 12.5 days (OR = 0.061; 95% CI: 0.021– 0.182) were independent protective factors for TO (all P < 0.05). The nomogram C-index was 0.931; the area under the ROC curve was 0.983 (95% CI: 0.971– 0.995), sensitivity was 0.948 and specificity was 0.929; the calibration curve fitted well with the ideal curve; and the decision curve showed that the model had a significant positive net benefit. Subgroup analysis based on resection extent (minor vs major hepatectomy) confirmed the model’s robust performance, with AUCs of 0.984 and 0.976 respectively, demonstrating consistent predictive accuracy across different surgical complexities.
Conclusion: Preoperative nutritional status, intraoperative blood loss and postoperative hospital stay are independent factors for achieving TO in laparoscopic resection of HCC. The constructed nomogram has excellent predictive performance and can be used to identify high-risk patients in the early clinical stage and guide individualised intervention.
Keywords: hepatectomy, hepatocellular carcinoma, textbook outcome, influencing factors, nomogram model
1Hepatobiliary Surgery, The First Affiliated Hospital of Ningbo University, Ningbo City, Zhejiang Province, 315020, People’s Republic of China; 2Nursing Department, The First Affiliated Hospital of Ningbo, Ningbo City, Zhejiang Province, 315020, People’s Republic of China; 3The Medical Engineering Department, The First Affiliated Hospital of Ningbo University, Ningbo City, Zhejiang Province, 315020, People’s Republic of China; 4Outpatient Department, The First Affiliated Hospital of Ningbo University, Ningbo City, Zhejiang Province, 315020, People’s Republic of China
Correspondence: Haofen Xie, Outpatient Department, The First Affiliated Hospital of Ningbo University, No. 247 Renmin Road, Jiangbei District, Ningbo City, Zhejiang Province, 315020, People’s Republic of China, Tel +86 13867889859, Email xihfff2022@126.com Xiaoping Yang, Hepatobiliary Surgery, the First Affiliated Hospital of Ningbo University, No. 247 Renmin Road, Jiangbei District, Ningbo City, Zhejiang Province, 315020, People’s Republic of China, Email yangxiaoping_56@21cn.com
Objective: To analyse the influencing factors for textbook outcome (TO) achievement in laparoscopic hepatectomy for hepatocellular carcinoma (HCC) and to construct and validate a nomogram model.
Methods: A total of 200 patients with HCC who underwent laparoscopic hepatectomy in our hospital between January 2022 and December 2024 were retrospectively analysed and divided into a TO group (n = 116) and a non-TO group (n = 84) according to the TO in liver surgery criteria. Twenty clinical parameters were collected, and after univariate analysis to screen variables, multivariate logistic regression was performed to determine independent influencing factors and establish nomograms. Model discrimination, calibration and clinical benefit were assessed using receiver operating characteristic (ROC) curves, calibration curves and decision curves.
Results: Multivariate logistic analysis showed that no malnutrition before operation (odds ratio [OR] = 0.051; 95% confidence interval [CI]: 0.014– 0.179), intraoperative blood loss < 225 mL (OR = 0.096; 95% CI: 0.030– 0.310) and postoperative hospital stay < 12.5 days (OR = 0.061; 95% CI: 0.021– 0.182) were independent protective factors for TO (all P < 0.05). The nomogram C-index was 0.931; the area under the ROC curve was 0.983 (95% CI: 0.971– 0.995), sensitivity was 0.948 and specificity was 0.929; the calibration curve fitted well with the ideal curve; and the decision curve showed that the model had a significant positive net benefit. Subgroup analysis based on resection extent (minor vs major hepatectomy) confirmed the model’s robust performance, with AUCs of 0.984 and 0.976 respectively, demonstrating consistent predictive accuracy across different surgical complexities.
Conclusion: Preoperative nutritional status, intraoperative blood loss and postoperative hospital stay are independent factors for achieving TO in laparoscopic resection of HCC. The constructed nomogram has excellent predictive performance and can be used to identify high-risk patients in the early clinical stage and guide individualised intervention.
Keywords: hepatectomy, hepatocellular carcinoma, textbook outcome, influencing factors, nomogram model