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Objective To evaluate the predictive value of functional liver imaging score(FLIS)based on preoperative gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid(Gd-EOB-DTPA)enhanced MRI for post-hepatectomy liver failure(PHLF)in patients with hepatocellular carcinoma(HCC).Methods The data of HCC patients who underwent extensive hepatectomy and preoperative Gd-EOB-DTPA enhanced MRI were analyzed retrospectively.The FLIS was scored based on the three features including liver parenchyma enhancement,biliary excretion and portal vein signal enhancement in hepatobiliary phase images,and the consistency between different observers was evaluated.Logistic regression model and receiver operating characteristic(ROC)curve were used to analyze the ability of FLIS to predict the PHLF.Results PHLF occurred in 29 of 120 HCC patients(24.2%).The intraclass correlation coefficient(ICC)of FLIS evaluated by two observers was 0.944.Multivariate logistic regression analysis showed that FLIS was an independent predictor of PHLF of HCC patients[odds ratio(OR)0.520,95%confidence interval(CI)0.355-0.726;P<0.001].The area under the curve(AUC)of FLIS for predicting the PHLF was 0.709,the optimal diagnostic threshold was 4,and the corresponding sensitivity and specificity were 78.0%and 58.6%.Conclusion Preoperative FLIS can predict the PHLF of HCC patients,which may help to make more accurate treatment plans for HCC patients.
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Objective To explore the predictive value of preoperative aspartate aminotransferase-to-platelet ratio index (APRI) for post-hepatectomy liver failure (PHLF) after hepatectomy in the patients with primary liver cancer (PLC). Methods A retrospective study was conducted on the data from the PLC patients who underwent first hepatectomy in Tumor Hospital Affiliated to Guangxi Medical University between Sep. 2013 and Dec. 2016. The logistic regression model and receiver operating characteristic (ROC) curve were performed to determine the predicting values of APRI, Child-Pugh score, model for end-stage liver disease (MELD) score and albumin-bilirubin (ALBI) score for PHLF. Results A total of 1 108 PLC patients were included in this study, and PHLF occurred in 217 (19.58%) patients. The logistic regression analysis showed that Child-Pugh score, MELD score, ALBI score and APRI were predicting factors for PHLF (all P0.05). The ROC curve analysis showed that preoperative APRI (area under curve [AUC]: 0.745, 95% confidence interval [CI] 0.709-0.781, P0.001) was significantly better for predicting PHLF compared with Child-Pugh score (AUC 0.561, 95% CI 0.516-0.605, P＝0.005), MELD score (AUC 0.650, 95% CI 0.610-0.691, P0.001) and ALBI score (AUC 0.662, 95% CI 0.621-0.703, P0.001). Based on Youden index, the best cut-off value of preoperative APRI was 0.55 for predicting PHLF in PLC patients, with a sensitivity of 71.9% and a specificity of 68.5%, and the patients with APRI0.55 had significantly higher overall incidence of PHLF, and higher incidence of PHLF A, B and C compared with ones with APRI≤0.55 (all P0.05). Conclusion Preoperative APRI is more accurate for predicting PHLF after hepatectomy in PLC patients versus the Child-Pugh, MELD and ALBI scores, providing guiding significance for clinical treatment of PLC.
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Objective: To explore the correlation between standard remnant liver volume(SRLV) and post-hepatectomy liver failure (PHLF)in patients with hepatocellular carcinoma(HCC)and cirrhotic livers.Methods:In total,181 patients who underwent hemihepa-tectomy in Affiliated Tumor Hospital of Guangxi Medical University from September 2013 to August 2016 were enrolled in the study. Total liver,tumor,remnant liver,and resected liver volumes were measured using the Myrian liver surgical planning system before sur-gery. Intraoperative resected liver volume (including resected normal liver and tumor volumes) were collected using the drainage method.The patients were divided into the PHLF(22 cases)and non-PHLF groups(159 cases)according to whether PHLF occurred based on the"50/50"criteria.The risk factors of PHLF were then explored.The cut-off of SRLV and efficiency of predicting PHLF were analyzed in the subgroup of patients with cirrhotic livers.The grade of liver cirrhosis was retrospectively analyzed using helical comput-ed tomography(CT).Results:Twenty-two of the 181 patients developed PHLF and one died of it.Preoperative total bilirubin levels and SRLV were identified as independent factors for predicting PHLF using a Logistic regression model.In total,102 patients with cirrhotic livers were selected in subgroup analysis based on postoperative cirrhotic pathology.Eighteen patients developed PHLF and one died of PHLF in the subgroup.Using receiver-operating characteristic(ROC)curve analysis,340 mL/m2was the cut-off of SRLV for patients with HCC and cirrhotic livers(area under the curve:0.861,P<0.01;sensitivity and specialty rates were 94.4% and 74.7%,respectively). Eighty-four cases were of grade Ⅰ or Ⅱ cirrhosis,18 cases were of grade Ⅲ cirrhosis,and there were no cases of grade Ⅳ cirrhosis based on retrospective analysis using helical CT.Conclusions:Patients with cirrhotic livers with an anticipated SRLV of≤340 Ml/m2after he-patic resection are at increased risk for PHLF after emihepatectomy.
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Objective To compare the discriminatory power of the Albumin-bilirubin score (ALBI) and the Child-Pugh score (CP) in predicting post-hepatectomy liver failure (PHLF) in patients with hepatocellular carcinoma (HCC) after curative liver resection,and to explore the clinical value of ALBI score.Methods The clinical data of HCC patients who underwent curative hepatectomy in Nanfang Hospital,Southern Medical University from January 2011 to December 2016 were retrospectively reviewed.The risk factors of PHLF were identified through logistic regression.The areas under the receiver operating characteristic (ROC) curve were calculated to measure the ALBI and CP scores in the prediction of PHLF.Results A total of 1 013 patients were enrolled.The incidence of PHLF was 17.7％ (179/1013).Both CP score (OR =1.94,P ＜ 0.05) and ALBI score (OR =3.85,P ＜ 0.05) were identified as independent predictors of PHLF on multivariable analysis.The incidence of PHLF in patients with CP grade A was significantly lower than those with CP grade B(16.4％,158/963 vs.42％,21/50;P ＜ 0.05).The incidences of PHLF in patients with AIBI 1,2 and 3 were 9.9％ (50/504),24.8％ (124/501) and 62.5％ (5/8),respectively (P ＜0.05),indicating that the incidences of PHLF increased significantly with increasing ALBI grades.Moreover,when the ALBI score further classified patients of the CP grade A into the ALBI 1-A and ALBI 2-A subgroups,the incidence of PHLF in patients with ALBI 1-A was significantly lower than that with ALBI 2-A (9.9％,50/504 vs.23.5％,108/459;P ＜0.05).The area under the ROC curve for the ALBI score in predicting PHLF was greater than that of the CP score (0.705 vs.0.630;P ＜ 0.05).Conclusions The prognostic power of the ALBI score was greater than that of the CP score in predicting PHLF.Even in patients with CP grade A,the ALBI score was more sensitive in identifying patients with a high risk of PHLF.The ALBI score is a useful tool to predict PHLF after hepatectomy in HCC patients.
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Objective To study the value of serum prealbumin-bilirubin score (PALBI) in predicting posthepatectomy liver failure (PHLF) for patients with HBV related hepatocellular carcinoma (HCC).Methods A retrospective study was conducted on 919 HBV-related HCC patients who underwent hepatectomy from September 2013 to December 2016 at the Affiliated Tumor Hospital of Guangxi Medical University.These patients were divided into a training cohort (n =689) and a validation cohort (n =230) using the 3 ∶ 1 matching principle.The training cohort was divided into the control group (n=546) and the PHLF group (n=143) according to whether PHLF occurred.The multivariate logistic regression model was used to analyze the factors related to PHLF in the training cohort,and then the PALBI score was established.The ability of the PALBI score to predict PHLF was evaluated by the area under the receiver operating characteristic curve (AUC) and compared with the Child-Pugh,model for end-stage liver disease (MELD),and albumin-bilirubin (ALBI) scores.Results Univariate and multivariate logistic regression analyses showed the factors including HBV-DNA≥ 103 IU/ml,total bilirubin,prealbumin,platelet count,AST,prothrombin time,intraoperative blood loss ≥400 ml and major liver resection were closely related to PHLF.The ability of the PALBI score (AUC =0.733) to predict PHLF preoperatively was superior to the ChildPugh score (AUC =0.562),the MELD score (AUC =0.652) and the ALBI score (AUC =0.683) in the entire training cohort.Similar results were obtained in the entire validation cohort (AUC:0.752 vs.0.599 vs.0.641 vs.0.678).To eliminate the effect of a small residual liver volume on PHLF,the ability of each of these scores in the training and validation cohorts to predict PHLF was calculated respectively in these 2 cohorts of patients who underwent only minor liver resection,and similar results were obtained.Conclusion The PALBI score was significantly superior to the Child-Pugh,MELD and ALBI scores in predicting PHLF in patients with HBV-related HCC who underwent liver resection.The PALBI score is a simple,non-invasive and reliable novel model in predicting PHLF.