Pediatric surgery international · 2026
Dynamic landmark models predicting native liver survival after kasai portoenterostomy: a bicentric study.
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Meng Yu, Yang Qianhui, Li Xin, Yu Pu, Ji Qi, Chen Yuqiang, Liu Zhijie, Yu Chen, Zhao Yilin, Qiu Yaqiong, Zhang Hui, Yang Yuan, Xiong Xiqian, Zhang Cong, Zhan Jianghua
Аннотация
OBJECTIVES: Native liver survival (NLS) after Kasai portoenterostomy (KPE) for biliary atresia (BA) is highly heterogeneous, and clinically practical approaches that update prognostic estimates across prespecified postoperative follow-up time points remain limited.
METHODS: In this retrospective bicentric cohort study (training, n = 168; validation, n = 80), Cox proportional hazards landmark models were developed at five prespecified time points (preoperative and 2 weeks, 1, 3, and 6 months post-KPE) using a LASSO/Boruta dual-algorithm intersection approach with variance inflation factor (VIF)-based collinearity pruning. Internal validation used 500-replicate bootstrap resampling; external validation was performed in an independent cohort.
RESULTS: Preoperative and 2-week models showed limited discrimination (C-index ≤0.576). The 3-month two-variable model (TBA + TBil clearance ratio [TBil-CR]) achieved a training C-index of 0.812 (optimism 0.003) and an external C-index of 0.778 (95% CI 0.679-0.878). Risk stratification yielded a 35-percentage-point difference in 2-year cumulative event rates (41.7% vs. 7.0%; log-rank P < 0.001), consistently reproduced in the validation cohort. TBil-CR HR declined progressively across postoperative landmarks, and its single-variable C-index exceeded the jaundice clearance criterion by 0.103 at 3 months.
CONCLUSIONS: A parsimonious two-variable landmark model incorporating TBil-CR and TBA at 3 months post-KPE accurately predicts long-term NLS in children with BA, outperforming traditional binary bilirubin thresholds.
METHODS: In this retrospective bicentric cohort study (training, n = 168; validation, n = 80), Cox proportional hazards landmark models were developed at five prespecified time points (preoperative and 2 weeks, 1, 3, and 6 months post-KPE) using a LASSO/Boruta dual-algorithm intersection approach with variance inflation factor (VIF)-based collinearity pruning. Internal validation used 500-replicate bootstrap resampling; external validation was performed in an independent cohort.
RESULTS: Preoperative and 2-week models showed limited discrimination (C-index ≤0.576). The 3-month two-variable model (TBA + TBil clearance ratio [TBil-CR]) achieved a training C-index of 0.812 (optimism 0.003) and an external C-index of 0.778 (95% CI 0.679-0.878). Risk stratification yielded a 35-percentage-point difference in 2-year cumulative event rates (41.7% vs. 7.0%; log-rank P < 0.001), consistently reproduced in the validation cohort. TBil-CR HR declined progressively across postoperative landmarks, and its single-variable C-index exceeded the jaundice clearance criterion by 0.103 at 3 months.
CONCLUSIONS: A parsimonious two-variable landmark model incorporating TBil-CR and TBA at 3 months post-KPE accurately predicts long-term NLS in children with BA, outperforming traditional binary bilirubin thresholds.