肝切除（LR）和局部肿瘤破坏（LTD）是有效的治疗方法，但不常推荐用于中晚期肝细胞癌（HCC）患者。该研究旨在探讨LR/LTD是否能改善这些患者的总体生存率（OS），并确定哪些患者最有可能从LR/LTD中受益。从2001年至2018年的Surveillance, Epidemiology, and End Results数据库中提取了中晚期HCC患者的数据。比较接受LR/LTD治疗和未接受治疗的HCC患者的OS。构建了一个预测OS的判定图，并进行了验证。共有535名合格患者，其中128名接受了LR/LTD，407名未接受。观察到接受LR/LTD治疗的患者的OS显著较高（P<0.001）。根据单变量和多变量分析得到的独立预后因子构建了一个判定图。判定图的C指数高于TNM分期系统（训练组：0.74 vs. 0.59；验证组：0.78 vs. 0.61）。同样，受试者工作特征曲线下面积和校准曲线表明判定图具有良好的准确性。决策曲线分析曲线显示判定图具有良好的临床实用性。此外，低风险患者（判定图得分：0-221.9）的OS较高风险患者（判定图得分：高于221.9）显著增加（P<0.001）。LR/LTD显著改善了中晚期HCC患者的OS。本研究开发的判定图在中晚期HCC患者的OS预测值较高，可能有助于选择最适合接受LR/LTD的患者。版权所有©2023张氏, 张氏, 何氏, 刘氏, 段氏, 黄氏, 黄氏, Lowe, 柯氏, 刘氏和曹氏。

Liver resection (LR) and local tumor destruction (LTD) are effective treatments, but not commonly recommended for patients with intermediate/advanced hepatocellular carcinoma (HCC). This study aimed to explore whether LR/LTD could improve overall survival (OS) of these patients, and to identify the patients who will most likely benefit from LR/LTD.Data of patients with intermediate/advanced HCC between 2001 and 2018 were extracted from Surveillance, Epidemiology, and End Results database. OS was compared between HCC patients who received LR/LTD and those who did not. A nomogram was constructed for predicting OS, and it was then validated.A total of 535 eligible patients were included, among which 128 received LR/LTD while 407 did not. Significantly higher OS in patients who received LR/LTD was observed (P<0.001). Based on independent prognostic factors obtained from univariate and multivariate analyses, a nomogram was constructed. The C-indices of nomogram were higher than those of the TNM staging system (training cohort: 0.74 vs. 0.59; validation cohort: 0.78 vs. 0.61). Similarly, areas under receiver operating characteristic curves and calibration curves indicated good accuracy of the nomogram. Decision curve analysis curves revealed good clinical practicability of the nomogram. Furthermore, low-risk patients (nomogram score: 0-221.9) had higher OS compared with high-risk patients (nomogram score: higher than 221.9) (P<0.001).LR/LTD significantly improves OS in patients with intermediate/advanced HCC. The nomogram developed in the present study shows high predicating value for OS in patients with intermediate/advanced HCC, which might be useful in selecting patients who are most suitable for LR/LTD.Copyright © 2023 Zhang, Zhang, He, Liu, Duan, Huang, Huang, Lowe, Ke, Liu and Cao.