Liver regeneration-associated machine learning architecture integrating time-phased predictions for post-hepatectomy liver failure

作者：Hao Shen, Tao Yuan, Anfeng Si, Yihang Shen, Jin Liu, Jin Lv, Zhihao Xie, Huayi Zhang, Wenxin Wei, Yizhe Dai, Tao Jiang, Chenxiang He, Shichao Zhang, Yuheng Hu, Shengyu Huang, Zhishi Yang, Yao Chen, Xiaofeng Zhang, Feng Shen, Xiaolong Qi, Jun Li · 发表于：EClinicalMedicine · 年份：2025 · DOI：10.1016/j.eclinm.2025.103661 · 被引用次数：3 · 研究领域：Hepatocellular Carcinoma Treatment and Prognosis、Artificial Intelligence in Healthcare、Organ Transplantation Techniques and Outcomes

Background: Post-hepatectomy liver failure (PHLF) is the leading cause of morbidity and mortality following major hepatectomy. Existing prediction models inadequately capture the dynamic liver regeneration and perioperative changes, limiting their predictive accuracy. We aimed to develop a machine learning (ML) modelling system (PILOT architecture) integrating liver regeneration-associated biomarkers with time-phased perioperative data for PHLF prediction. Methods: This retrospective multicentre study included 1071 patients undergoing major hepatectomy at three centres (2019-2024), divided into training (n = 623) and two external validation cohorts (n = 206 and 242). Fifty-five perioperative variables, including novel liver regeneration-associated biomarkers (GATA3, RAMP2, VEGFA, PEDF), were categorised into three time-phased datasets (preoperative, intraoperative, postoperative). Thirteen ML algorithms were evaluated across these datasets, with gradient-based feature reduction strategies applied to optimise the PILOT models. This study is registered with ClinicalTrials.gov (NCT05779098). Findings: < 0.050). A risk-stratification framework integrating PILOT-Pre and PILOT-Intra predictions achieved a class-specific precision of 94.4%-96.6% for PHLF events in the consensus high-risk group and 92.1%-95.5% for non-PHLF events in the consensus low-risk populations. SHAP analysis revealed that serum phosphorus levels >2.4 mg/dL on postoperative day 3, liver RAMP2-GATA3 ratios <10.1...