Prediction of post-hepatectomy liver failure for hepatocellular carcinoma by model for end-stage liver disease and standardized future liver remnant

Abstract

Abstract: Objective To evaluate the value of standardized future liver remnant (sFLR) and score of model for end-stage liver disease (MELD) in predicting post-hepatectomy liver failure (PHLF) in patients with hepatocellular carcinoma (HCC). Methods From October 2015 to February 2021, seventy-four HCC patients including 58 males and 16 females who underwent abdominal three-dimensional CT reconstruction and hepatectomy were enrolled in this study. Univariate and multivariate Logistic regression analysis were used to explore the influencing factors related to PHLF. Receiver operating characteristic curve (ROC) analysis was used to determine the independent influencing factors of PHLF. Results There were 28 PHLF cases (PHLF group) and 46 non-PHLF cases (non-PHLF group) in 74 HCC patients. The PLT, Alb, sFLR and MELD scores of patients in PHLF group and non-PHLF group were 123 (29, 238)×10⁹/L and 168 (38, 538)×10⁹/L, 36.3 (26.0, 41.2) g/L and 42.8 (25.6, 48.8) g/L, 0.50 (0.38, 0.78) and 0.67(0.36, 0.99), 9 (6,12) points and 7 (6,10) points, respectively, with statistically significant differences (P<0.05). There was no significant difference in age, sex, PT, INR, ALT, HBsAg and tumor diameter between these two groups (P>0.05). The scores of PLT, Alb, sFLR and MELD were included in multivariate Logistic regression analysis, and the result showed that PLT, Alb, sFLR and MELD were independent predictors of PHLF in HCC patients (P<0.05). The cutoff value, sensitivity and specificity of sFLR in diagnosing PHLF in HCC patients were 0.54, 76.9% and 73.9%, respectively, while the cutoff value, sensitivity and specificity of MELD score in diagnosing PHLF in HCC patients were 8.5, 53.8% and 82.6%, respectively. The AUC value of sFLR in combination with MELD score in diagnosing PHLF in HCC patients were significantly higher than that of sFLR or MELD score alone (P<0.05). Conclusion sFLR in combination with MELD score is an effective index to predict PHLF in HCC patients. This prediction model can effectively guide the early treatment, improve prognosis and reduce mortality of HCC patients after hepatectomy, and provide a new method for preoperative evaluation.

Key words: Hepatocellular carcinoma, Post-hepatectomy liver failure, Standardized future liver remnant, Model for end-stage liver disease

ZHANG Feng-xiao, BAI Xue-song, HU Jinghua. Prediction of post-hepatectomy liver failure for hepatocellular carcinoma by model for end-stage liver disease and standardized future liver remnant[J]. Chinese Hepatolgy, 2022, 27(2): 196-198.

References

[1] Hajji SE, Balaphas A, Toso C, et al. Preoperative platelet count does not predict the occurrence of post-hepatectomy liver failure after partial hepatectomy in a retrospective monocentric cohort study. Medicine (Baltimore), 2021, 100:e24425.
[2] Bae JS, Lee DH, Yoo J, et al. Association between spleen volume and the post-hepatectomy liver failure and overall survival of patients with hepatocellular carcinoma after resection. Eur Radiol, 2021, 31:2461-2471.
[3] Chin KM, Koh YX, Syn N, et al. Early prediction of post-hepatectomy liver failure in patients undergoing major hepatectomy using a PHLF prognostic nomogram. World J Surg, 2020, 44:4197-4206.
[4] Tsujita Y, Sofue K, Komatsu S, et al. Prediction of post-hepatectomy liver failure using gadoxetic acid-enhanced magnetic resonance imaging for hepatocellular carcinoma with portal vein invasion. Eur J Radiol, 2020, 130:109189.
[5] Shehta A, Farouk A, Fouad A, et al. Post-hepatectomy liver failure after hepatic resection for hepatocellular carcinoma: a single center experience. Langenbecks Arch Surg, 2021, 406:87-98.
[6] Mai RY, Zeng J, Lu HZ, et al. Combining aspartate aminotransferase-to-platelet ratio index with future liver remnant to assess preoperative hepatic functional reserve in patients with hepatocellular carcinoma. J Gastrointest Surg, 2021, 25:688-697.
[7] Kong FH, Miao XY, Zou H, et al. End-stage liver disease score and future liver remnant volume predict post-hepatectomy liver failure in hepatocellular carcinoma. World J Clin Cases, 2019, 7:3734-3741.
[8] Fagenson AM, Gleeson EM, Pitt HA, et al. Albumin-bilirubin score vs model for end-stage liver disease in predicting post-hepatectomy outcomes. J Am Coll Surg, 2020, 230:637-645.
[9] Rahbari NN, Garden OJ, Padbury R, et al. Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery, 2011, 149: 713-724.
[10] Gong WF, Zhong JH, Lu Z, et al. Evaluation of liver regeneration and post-hepatectomy liver failure after hemihepatectomy in patients with hepatocellular carcinoma. Biosci Rep, 2019, 39:BSR20190088.
[11] Wang Z, Wu YF, Yue ZD, et al. Comparative study of indocyanine green-R15, Child-Pugh score, and model for end-stage liver disease score for prediction of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt. World J Gastroenterol, 2021, 27:416-427.
[12] Delis SG, Bakoyiannis A, Biliatis I, et al. Model for end-stage liver disease (MELD) score, as a prognostic factor for post-operative morbidity and mortality in cirrhotic patients, undergoing hepatectomy for hepatocellular carcinoma. HPB (Oxford), 2009, 11:351-357.
[13] Hsu KY, Chau GY, Lui WY, et al. Predicting morbidity and mortality after hepatic resection in patients with hepatocellular carcinoma: the role of Model for End-Stage Liver Disease score. World J Surg, 2009, 33:2412-2419.
[14] Huang D, Shen Y, Zhang W, et al. A preoperative nomogram predicts prognosis of patients with hepatocellular carcinoma after liver transplantation: a multicenter retrospective study. BMC Cancer, 2021, 21:280.
[15] Zou H, Wen Y, Yuan K, et al. Combining albumin-bilirubin score with future liver remnant predicts post-hepatectomy liver failure in HBV-associated HCC patients. Liver Int, 2018, 38:494-502.