Exploring the dynamics of postoperative symptom networks in liver cancer patients: a cross‑lagged panel network analysis

Abstract Objective: To dynamically analyze symptom networks of hepatocellular carcinoma patients at 3 early postoperative time points using cross-lagged network analysis and to explore predictive relationships between postoperative. Methods: A longitudinal study was conducted involving 498 hepatocellular carcinoma patients who underwent surgical treatment at a tertiary hospital in Kunming between February 2024 and March 2025. The Anderson Symptom Scale and a hepatocellular carcinoma-specific module were used to assess symptom prevalence and severity on postoperative day 2 (T1), day 4 (T2), and day 7 (T3). Cross-lagged networks were constructed using longitudinal data in R software to identify key symptom nodes and explore predictive and interactive relationships. Results: Fatigue exhibited the highest out-strength and out-expected influence (out-EI) during both T1→T2 and T2→T3. Specifically, during T1→T2, fatigue (out-strength=0.10, out-EI=0.10) was prospectively associated with distress, heartburn, and shortness of breath at T2. During T2→T3, fatigue (out-strength=0.24, out-EI=0.24) was prospectively associated with poor appetite, bloating, and jaundice at T3. Conclusion: During the early postoperative period, fatigue consistently was prospectively associated with subsequent symptoms and had predictive value in hepatocellular carcinoma patients. Fatigue should be prioritized as a key symptom for monitoring and intervention in clinical symptom management to optimize treatment strategies.