A predictive model incorporating inflammation markers for high-grade surgical complications following liver resection for hepatocellular carcinoma

Abstract

Background: Systemic inflammation and immune deficiency predispose surgical patients to infection and adversely affect postoperative recovery. We aimed to evaluate the prognostic ability of inflammation and immune-nutritional markers and to develop a predictive model for high-grade complications after resection of hepatocellular carcinoma (HCC). Methods: This study enrolled 1431 patients undergoing liver resection for primary HCC at a medical center. Preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, prognostic nutritional index, Model for End-Stage Liver Disease score, Albumin-Bilirubin score, Fibrosis-4 score, and Aspartate Aminotransferase to Platelet Ratio Index score were assessed. Stepwise backward variable elimination was conducted to determine the factors associated with Clavien-Dindo grade III to V complications within 30-day postoperative period. The predictive model was internally validated for discrimination performance using area under the receiver operating characteristic curve (AUC). Results: A total of 106 (7.4%) patients developed high-grade complications. Four factors independently predicted a high-grade postoperative complication and were integrated into the predictive model, including NLR (adjusted odds ratio: 1.10, 95% confidence interval [CI], 1.02-1.19), diabetes mellitus, extent of hepatectomy, and intraoperative blood loss. The AUC of the model was 0.755 (95% CI, 0.678-0.832) in the validation dataset. Using the cutoff value based on Youden’s index, the sensitivity and specificity of the risk score were 59.0% and 76.3%, respectively. Conclusion: Preoperative NLR independently predicted a high-grade complication after resection of HCC. The predictive model allows for identification of high-risk patients and appropriate modifications of perioperative care to improve postoperative outcomes.

Blood urea nitrogen and creatinine in in-hospital cardiac arrest patients

“…Biochemistry and simple complete blood counts may be one of the most frequently used tests in clinical routine practice, and besides history and physical examination, both parameters are considered more convenient and less costly with rapid availability to help physicians clarify what the urgency of a patient's condition is. 7,8,11 However, these simple tests are often influenced by many confounding factors, and all may result in misinterpretation easily, leading to misjudgment in the diagnosis and severity of diseases in patients, [12][13][14] and contributing to the uncertainty of the roles of biochemistry and simple complete blood counts. In fact, as shown by the authors, the role of BCR was inconformity.…”

Minimally invasive surgery for hepatocellular carcinoma

“…[1][2][3][4] Despite recent far-advanced medical treatments, primary surgical resection of the tumor remains the gold standard treatment for resectable HCC and/or an isolated metastatic hepatic cancer. 5 Similar to all other cancers, traditional surgery (exploratory laparotomy) and minimally invasive surgery (MIS: laparoscopy or robot) have been reported to be applicable for the aforementioned purpose, although some uncertainties are still in concerns if MIS is applied to many cancers. [6][7][8][9] It is well known that MIS may have taken many advantages, such as a better recovery, a better cosmetic need, and a shortening hospital stay (all are called a better quality of life [QoL]) compared with traditional surgery, some surgical oncologists still hesitate to receive the MIS as the choice of treatment for their patients because of much concern for the long-term oncological safety.…”

“…13 The risk of reduced liver functional reserve after resection of HCC was reported nearly half of patients (47.7%). 5 A recent retrospective study in five high-volume centers in 2023 also supported the advantages of using RH in the management of HCC patients compared with OH, based on a significantly shorter hospital length of stay (median [IQR: interval of reference], 4 [3][4][5][6] days vs 10 [7-13] days), a lower number of admissions to the intensive care unit (7 [6.6%] vs 21 [19.8%]), and a lower incidence of posthepatectomy liver failure (8 [7.5%] vs 30 [28.3%]), with no cases of grade C failure, although a significantly longer operative time (median [IQR], 295 minutes vs 200 [165-255] minutes, including docking) was found in the RH group compared to OH. 16 Additionally, the survival rate was also better in the RH group, with the similar 90-day OS rate between the 2 groups (RH, 99.1% [95% CI, 93.5%-99.9%]; OH, 97.1% [95% CI, 91.3%-99.1%]), and a better trend of cumulative incidence of death related to tumor recurrence (RH, 8.8% [95% CI, 3.1%-18.3%]; OH, 10.2% [95% CI, 4.9%-17.7%]).…”

Winners of the 2022 honor awards for excellence at the annual meeting of the Chinese Medical Association-Taipei: Part I

“…1 Traditionally, the therapy of HCC patients is based the Barcelona Clinic Liver Cancer (BCLC) stage system. [4][5][6] Noncirrhotic HCC patients with BCLC stage 0-A could be treated with resection surgery or local ablation. 4,5 HCC patients with multiple tumors or BCLC stage B and preserved liver function could be treated with transarterial chemoembolization (TACE).…”

“…[4][5][6] Noncirrhotic HCC patients with BCLC stage 0-A could be treated with resection surgery or local ablation. 4,5 HCC patients with multiple tumors or BCLC stage B and preserved liver function could be treated with transarterial chemoembolization (TACE). [4][5][6] Systemic therapy is appropriate in patients with BCLC stage C. 6 Many HCC patients were associated with cirrhosis (end-stage liver disease).…”