Hepatobiliary surgery and nutrition · 2023
A combined pre- and intra-operative nomogram in evaluation of degrees of liver cirrhosis predicts post-hepatectomy liver failure: a multicenter prospective study.
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Liang Bin-Yong, Zhang Er-Lei, Li Jian, Long Xin, Wang Wen-Qiang, Zhang Bi-Xiang, Zhang Zhi-Wei, Chen Yi-Fa, Zhang Wan-Guang, Mei Bin, Xiao Zhen-Yu, Gu Jin, Zhang Zun-Yi, Xiang Shuai, Dong Han-Hua, Zhang Lei, Zhu Peng, Cheng Qi, Chen Lin, Zhang Zhan-Guo, Zhang Bin-Hao, Dong Wei, Liao Xiao-Feng, Yin Tao, Wu Dong-De, Jiang Bin, Yuan Yu-Feng, Zhang Zhong-Lin, Chen Yao-Bing, Li Kai-Yan, Lau Wan Yee, Chen Xiao-Ping, Huang Zhi-Yong
Аннотация
BACKGROUND: Adequate evaluation of degrees of liver cirrhosis is essential in surgical treatment of hepatocellular carcinoma (HCC) patients. The impact of the degrees of cirrhosis on prediction of post-hepatectomy liver failure (PHLF) remains poorly defined. This study aimed to construct and validate a combined pre- and intra-operative nomogram based on the degrees of cirrhosis in predicting PHLF in HCC patients using prospective multi-center's data.
METHODS: Consecutive HCC patients who underwent hepatectomy between May 18, 2019 and Dec 19, 2020 were enrolled at five tertiary hospitals. Preoperative cirrhotic severity scoring (CSS) and intra-operative direct liver stiffness measurement (DSM) were performed to correlate with the Laennec histopathological grading system. The performances of the pre-operative nomogram and combined pre- and intra-operative nomogram in predicting PHLF were compared with conventional predictive models of PHLF.
RESULTS: For 327 patients in this study, histopathological studies showed the rates of HCC patients with no, mild, moderate, and severe cirrhosis were 41.9%, 29.1%, 22.9%, and 6.1%, respectively. Either CSS or DSM was closely correlated with histopathological stages of cirrhosis. Thirty-three (10.1%) patients developed PHLF. The 30- and 90-day mortality rates were 0.9%. Multivariate regression analysis showed four pre-operative variables [HBV-DNA level, ICG-R15, prothrombin time (PT), and CSS], and one intra-operative variable (DSM) to be independent risk factors of PHLF. The pre-operative nomogram was constructed based on these four pre-operative variables together with total bilirubin. The combined pre- and intra-operative nomogram was constructed by adding the intra-operative DSM. The pre-operative nomogram was better than the conventional models in predicting PHLF. The prediction was further improved with the combined pre- and intra-operative nomogram.
CONCLUSIONS: The combined pre- and intra-operative nomogram further improved prediction of PHLF when compared with the pre-operative nomogram.
TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT04076631.
METHODS: Consecutive HCC patients who underwent hepatectomy between May 18, 2019 and Dec 19, 2020 were enrolled at five tertiary hospitals. Preoperative cirrhotic severity scoring (CSS) and intra-operative direct liver stiffness measurement (DSM) were performed to correlate with the Laennec histopathological grading system. The performances of the pre-operative nomogram and combined pre- and intra-operative nomogram in predicting PHLF were compared with conventional predictive models of PHLF.
RESULTS: For 327 patients in this study, histopathological studies showed the rates of HCC patients with no, mild, moderate, and severe cirrhosis were 41.9%, 29.1%, 22.9%, and 6.1%, respectively. Either CSS or DSM was closely correlated with histopathological stages of cirrhosis. Thirty-three (10.1%) patients developed PHLF. The 30- and 90-day mortality rates were 0.9%. Multivariate regression analysis showed four pre-operative variables [HBV-DNA level, ICG-R15, prothrombin time (PT), and CSS], and one intra-operative variable (DSM) to be independent risk factors of PHLF. The pre-operative nomogram was constructed based on these four pre-operative variables together with total bilirubin. The combined pre- and intra-operative nomogram was constructed by adding the intra-operative DSM. The pre-operative nomogram was better than the conventional models in predicting PHLF. The prediction was further improved with the combined pre- and intra-operative nomogram.
CONCLUSIONS: The combined pre- and intra-operative nomogram further improved prediction of PHLF when compared with the pre-operative nomogram.
TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT04076631.