A Novel Nomogram for Predicting Postoperative Liver Failure After Major Hepatectomy for Hepatocellular Carcinoma

Abstract

BackgroundPost-hepatectomy liver failure (PHLF) is the most common cause of mortality after major hepatectomy in hepatocellular carcinoma (HCC) patients. We aim to develop a nomogram to preoperatively predict grade B/C PHLF defined by the International Study Group on Liver Surgery Grading (ISGLS) in HCC patients undergoing major hepatectomy.Study DesignThe consecutive HCC patients who underwent major hepatectomy at the Eastern Hepatobiliary Surgery Hospital between 2008 and 2013 served as a training cohort to develop a preoperative nomogram, and patients from 2 other hospitals comprised an external validation cohort. Least absolute shrinkage and selection operator (LASSO) logistic regression was applied to identify preoperative predictors of grade B/C PHLF. Multivariable logistic regression was utilized to establish a nomogram model. Internal and external validations were used to verify the performance of the nomogram. The accuracy of the nomogram was also compared with the conventional scoring models, including MELD and ALBI score.ResultsA total of 880 patients who underwent major hepatectomy (668 in the training cohort and 192 in the validation cohort) were enrolled in this study. The independent risk factors of grade B/C PHLF were age, gender, prothrombin time, total bilirubin, and CSPH, which were incorporated into the nomogram. Good prediction discrimination was achieved in the training (AUROC: 0.73) and validation (AUROC: 0.72) cohorts. The calibration curve also showed good agreement in both training and validation cohorts. The nomogram has a better performance than MELD and ALBI score models.ConclusionThe proposed nomogram showed more accurate ability to individually predict grade B/C PHLF after major hepatectomy in HCC patients than MELD and ALBI scores.

Current evidence on posthepatectomy liver failure: comprehensive review

“…Even though stem cell therapy might not be considered a classical medical treatment, it probably represents one of the most promising treatment alternatives for patients with PHLF in the future. Over the past years numerous publications have been addressing different treatment aspects, mainly in liver diseases such as fibrosis 195 and end-stage liver disease 196 . Results following mesenchymal stem cell transplantation in a porcine hepatectomy model have shown promising results 197 , 198 ; however, this treatment presently has not reached clinical practice, and several limitations remain critical, such as target-organ infiltration and the number of administered cells 199 .…”

Validating Hepatectomy Eligibility Criteria for Super Elderly Patients: A Retrospective Cohort Study

“…The finding that females had a lower rate of postoperative complications suggests that gender may play a role in the outcomes following surgery. Indeed, several studies have reported similar findings regarding the association between gender and the occurrence and severity of postoperative complications 26,27) . However, it is important to note that factors such as age, comorbidities, and individual variations may also contribute to these differences.…”

99mTc-GSA scintigraphy and modified albumin–bilirubin score can be complementary to ICG for predicting posthepatectomy liver failure

“…Multivariate logistic regression analysis was performed to con rm whether ALBI score, ICG-R15, and LHL15 are independent risk factors for PHLF. Age and major hepatectomy, which are considered to be associated with PHLF, [33][34][35] and each factor (ALBI score, ICG-R15, and LHL15) were included in the model as adjusted factors. We also performed univariable logistic regression analysis to con rm the association between each factor and PHLF.…”