Correlation of postoperative splenic volume increase with prognosis of hepatocellular carcinoma after curative hepatectomy

Abstract

Background: Previous studies have reported a close connection between the spleen and hepatic tumours. We investigated the prognostic value of postoperative splenic volume increase (PSVI) in patients with hepatocellular carcinoma after curative hepatectomy. Methods: This was a retrospective study of adult patients with hepatocellular carcinoma who underwent hepatectomy between January 2007 and May 2013. We categorized patients into 2 groups according to the cutoff value of the receiver operating characteristic curve: group A (PSVI < 19.0%) and group B (PSVI ≥ 19.0%). We compared the clinicopathological data, overall survival and disease-free survival between the 2 groups. We performed univariate and multivariate analyses to identify factors associated with disease-free and overall survival. Results: There were 275 patients in group A and 196 patients in group B. The 1-, 3and 5-year overall survival rates were 98.9%, 74.9% and 63.6%, respectively, for patients in group A, and 97.4%, 65.3% and 49.8%, respectively, for patients in group B (p = 0.004). The corresponding disease-free survival rates were 69.5%, 48.0% and 40.3%, and 58.1%, 36.5%, and 29.8% (p = 0.01). On multivariate analysis, PSVI was an independent predictor of overall (p = 0.01) and disease-free (p = 0.03) survival. Conclusion: Postoperative splenic volume increase correlates with poor prognosis of patients with hepatocellular carcinoma after curative hepatectomy. Contexte : Des études antérieures faisaient état d'un lien étroit entre la rate et les tumeurs hépatiques. Nous avons étudié la valeur pronostique de l'augmentation postopératoire du volume de la rate (APVR) chez les patients ayant subi une hépatectomie curative en raison d'un carcinome hépatocellulaire. Méthodes : Il s'agit d'une étude rétrospective portant sur des adultes qui ont subi une hépatectomie entre janvier 2007 et mai 2013 pour cause de carcinome hépatocellulaire. Nous avons classé les patients en 2 groupes, selon un seuil sur la courbe ROC : le groupe A (APVR : < 19,0 %) et le groupe B (APVR : ≥ 19,0 %). Nous avons ensuite comparé les données clinicopathologiques, le taux de survie globale et le taux de survie sans récidive des 2 groupes, et avons effectué des analyses univariées et multivariées pour repérer les facteurs associés à la survie sans récidive et à la survie globale. Résultats : Le groupe A comptait 275 patients, tandis que le groupe B en comptait 196. Les taux de survie globale à 1 an, à 3 ans et à 5 ans étaient de 98,

Role of post‐hepatectomy portal hypertension in predicting the outcome of hepatocellular carcinoma after curative resection

“…Major hepatectomy leads to drastic damage to the sinusoidal structure, extensive loss of the hepatic vascular bed, and obstruction of outflow. These structural changes would contribute to arterial hypoperfusion and pathological increases in intrahepatic vascular resistance, further increasing portal pressure 7,28 . Scarring in the cirrhotic liver leads to a reduction in elasticity and an increase in stiffness, which further contributes to an increased portal vein pressure gradient following liver resection 26 .…”

“…These structural changes would contribute to arterial hypoperfusion and pathological increases in intrahepatic vascular resistance, further increasing portal pressure. 7,28 Scarring in the cirrhotic liver leads to a reduction in elasticity and an increase in stiffness, which further contributes to an increased portal vein pressure gradient following liver resection. 26 Therefore, more attention should be paid to the possibility of PHPH in high-risk patients with HBV infection, cirrhosis, or elevated ALT levels, and the use of drugs to decrease portal pressure should be considered.…”

The impact of hepatic and splenic volumetric assessment in imaging for chronic liver disease: a narrative review

“…For example, using gadoxetic acid liver MRI can provide measurements of liver enhancement, from non-contrast and 20-min delayed post-contrast phases, to assess liver function for the prediction of PHLF [120]. Spleen volume, with and without adjustment to future remnant liver volume, BSA or platelets, has also been correlated with PHLF and survival [121][122][123][124][125][126][127][128][129]. The use of liver and spleen volumetry has also been studied in predicting outcomes following locoregional treatments such as thermal ablation, transarterial chemoembolisation and transarterial radioembolisation and following systemic therapy [130][131][132][133][134][135][136].…”