Development and Validation of a Machine Learning Prediction Model for Textbook Outcome in Liver Surgery: Results From a Multicenter, International Cohort

作者：Jane Wang, Amir Ashraf‐Ganjouei, Taizo Hibi, Núria Lluís, Camilla Gomes, Fernanda Romero‐Hernandez, Han Yin, Lucia Calthorpe, Yukiyasu Okamura, Yuta Abe, Shogo Tanaka, Minoru Tanabe, Zeniche Morise, Horacio J. Asbun, David A. Geller, Mohammad Abu Hilal, Mohamed A. Adam, Adnan Alseidi, International Hepatectomy Study Group · 发表于：Annals of Surgery Open · 年份：2025 · DOI：10.1097/as9.0000000000000539 · 被引用次数：3 · 研究领域：Hepatocellular Carcinoma Treatment and Prognosis、Surgical Simulation and Training、Radiomics and Machine Learning in Medical Imaging

Objective: This study aimed to (1) develop a machine learning (ML) model that predicts the textbook outcome in liver surgery (TOLS) using preoperative variables and (2) validate the TOLS criteria by determining whether TOLS is associated with long-term survival after hepatectomy. Background: Textbook outcome is a composite measure that combines several favorable outcomes into a single metric and represents the optimal postoperative course. Recently, an expert panel of surgeons proposed a Delphi consensus-based definition of TOLS. Methods: Adult patients who underwent hepatectomies were identified from a multicenter, international cohort (2010–2022). After data preprocessing and train-test splitting (80:20), 4 models for predicting TOLS were trained and tested. Following model optimization, the performance of the models was evaluated using receiver operating characteristic curves, and a web-based calculator was developed. In addition, a multivariable Cox proportional hazards analysis was conducted to determine the association between TOLS and overall survival (OS). Results: A total of 2059 patients were included, with 62.8% meeting the criteria for TOLS. The XGBoost model, which had the best performance with an area under the curve of 0.73, was chosen for the web-based calculator. The most predictive variables for having TOLS were a minimally invasive approach, fewer lesions, lower Charlson Comorbidity Index, lower preoperative creatinine levels, and smaller lesions. In the mu...