Objective
This study aimed to investigate the dynamic temporal associations among postoperative symptoms in patients with liver cancer using a cross-lagged panel network (CLPN) model, and to identify stage-specific core symptoms to inform targeted clinical interventions.
Methods
A longitudinal study was conducted involving 230 patients with liver cancer. Symptoms were assessed using the MD Anderson Symptom Inventory (MDASI) and the Symptom Module Specific to Primary Liver Cancer (SM-PLC) at five time points: 2 days (T1), 1 week (T2), 3 weeks (T3), 1 month (T4), and 3 months (T5) postoperatively. A CLPN model was applied to estimate cross-lagged associations among symptoms. Out-expected influence (out-EI) and in-expected influence (in-EI) were calculated to identify central symptoms within the dynamic network.
Results
From T1 to T2, jaundice exhibited the highest out-EI and significantly predicted vomiting (OR = 1.94, 95% CI [1.70, 2.14]). Pruritus predicted numbness (OR = 1.41, 95% CI [1.31, 1.52]), and pain predicted sadness (OR = 1.35, 95% CI [1.05, 1.47]). From T2 to T3, vomiting showed the highest out-EI and predicted jaundice (OR = 2.64, 95% CI [2.17, 2.84]), while bidirectional associations were observed between numbness and pruritus (OR = 2.64, 95% CI [2.17, 2.74]; OR = 1.21, 95% CI [1.00, 1.71]). From T3 to T4, vomiting predicted bloating (OR = 1.57, 95% CI [1.00, 1.64]) and loss of appetite (OR = 1.41, 95% CI [1.07, 1.62]), while fever predicted loss of appetite (OR = 1.28, 95% CI [1.14, 1.42]). From T4 to T5, sadness exhibited the highest out-EI and predicted disturbed sleep (OR = 1.35, 95% CI [1.22, 1.47]), loss of appetite (OR = 1.21, 95% CI [1.15, 1.46]), and fatigue (OR = 1.26, 95% CI [1.15, 1.51]).
Conclusions
Postoperative symptom dynamics in patients with liver cancer demonstrate clear stage-specific patterns. Jaundice and vomiting dominate early postoperative phases, whereas sadness becomes the central symptom in later stages. These findings may inform time-sensitive and symptom-targeted nursing interventions to improve postoperative symptom management.