Risk factors for posthepatectomy liver failure in patients with hepatocellular carcinoma and construction of prediction model / 中华消化外科杂志

ABSTRACT

Objective:To investigate the risk factors for posthepatectomy liver failure (PHLF) in patients with hepatocellular carcinoma and construction of prediction model.Methods:The retrospective case-control study was conducted. The clinicopathological data of 116 patients with hepatocellular carcinoma who underwent hepatectomy in the First Affiliated Hospital of University of Science and Technology of China from January 2019 to January 2022 were collected. There were 99 males and 17 females, aged (59±10)years. Observation indicators (1) occurrence of PHLF; (2) analysis of factors influencing the occurrence of PHLF; (3) construction and evaluation of prediction model for PHLF. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distri-bution were represented as M( Q1, Q3), and comparison between groups was conducted using the rank sum test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test or Fisher exact probability. The univariate analysis was conducted using the corresponding statistical methods based on data type. Multivariate analysis was conducted using the Logistic regression model with forward method. The regression coefficient was used to construct the prediction model. The receiver operating characteristic curve was drawn, and the area under curve (AUC) was used to evaluate the predictive ability of prediction model. Results:(1) Occurrence of PHLF. Of the 116 patients, there were 27 cases with PHLF and 89 cases without PHLF, respectively. Of the 27 patients with PHLF, 13 cases underwent laparoscopic hepatectomy and 14 cases underwent open hepatectomy. (2) Analysis of factors influencing the occurrence of PHLF. Results of multivariate analysis showed preoperative portal vein tumor thrombus and preoperative indocyanine green retention at 15 minutes (ICG R15) ≥10% were independent risk factors influencing the occurrence of PHLF ( odds ratio=13.463, 4.702, 95% confidence interval as 3.140-57.650, 1.600-13.800, P<0.05). (3) Construction and evaluation of prediction model for PHLF. According to the multivariate analysis, preoperative portal vein tumor thrombus and preoperative ICG R15 were included to construct the prediction model for predicting the occurrence of PHLF in patients with hepatocellular carcinoma. The AUC, sensitivity, specificity of prediction model was 0.750 (95% confidence interval as 0.654-0.846, P<0.05), 0.551, 0.852, respectively. Conclusions:Preoperative portal vein tumor thrombus and preoperative ICG R15 ≥10% are independent risk factors influen-cing the occurrence of PHLF. The prediction model based on these two factors has good efficacy in predicting PHLF of patients with hepatocellular carcinoma.