Predictors of mortality within the first year post-hepatectomy for hepatocellular carcinoma

Abstract

Background Hepatic resection (HR) for hepatocellular carcinoma (HCC) is safe with good perioperative and long-term oncologic outcomes. There is a paucity of data with regards to intermediate-term outcomes (i.e., beyond 90-day and within 1-year mortality). This paper studies the risk factors for within 1-year mortality after elective HR with curative intent in patients with HCC. Methods An audit of patients who underwent curative HR for HCC from January 2007 to April 2016 was conducted. Univariate and multivariate analysis were sequentially performed on perioperative variables using Cox-regression analysis to identify factors predicting intermediate-term outcomes defined as within 1-year mortality. Kaplan–Meier survival curves and hazard ratios were obtained. Results Three hundred forty-eight patients underwent HR during the study period and 163 patients had curative hepatectomy for HCC. Fifteen patients (9.2%) died within 1-year after HR. Multivariate analysis identified Child-Pugh class B/C (HR 5.5, p = 0.035), multinodularity (HR 7.1, p = 0.001), macrovascular invasion (HR 4.2, p = 0.04) postoperative acute renal failure (HR 5.8, p = 0.049) and posthepatic liver failure (HR 9.6, p = 0.009) as significant predictors of 1-year mortality. Conclusion One-year mortality following HR for HCC remains high and can be predicted preoperatively by multinodularity, Child-Pugh class, and macrovascular invasion. Postoperative acute renal failure and liver failure are associated with 1-year mortality.

Prognostic prediction of the platelet-to-lymphocyte ratio in hepatocellular carcinoma: a systematic review and meta-analysis

“…The potential cause may be that unpublished studies reported negative results. In addition, the prognosis of HCC is not only determined by PLR but also influenced by multiple factors such as surgical complications ( 54 ). It is better to consider all the prognostic factors together in clinic.…”

A combined pre- and intra-operative nomogram in evaluation of degrees of liver cirrhosis predicts post-hepatectomy liver failure: a multicenter prospective study

“…Therefore, in patients with large tumors and cirrhosis, more strict selection criteria for hepatectomy are required, especially emphasizing the evaluation of cirrhotic severity. Some studies suggested that the 90-day mortality was usually higher than the 30-day mortality (39,40). The Japanese National Clinical Database showed the 30-and 90-day mortality rates after hepatectomy to be 2% and 4%, respectively (40).…”

Does size matter for resection of giant versus non-giant hepatocellular carcinoma? A meta-analysis

“…Additionally, many studies did not specify which postoperative complications the patients experienced, and only 6 of the 24 studies[ 22 , 27 , 30 , 31 , 34 , 37 ] specified if the patients developed PHLF. Since PHLF has been found to be an independent predictor of mortality[ 2 ], the development of PHLF after HCC resection may be more indicative of the safety profile than complication rates alone. Thus, to improve the safety profile assessment of surgical resection, more precise reporting of major postoperative complications, particularly PHLF, and reporting of the 90-d mortality rate are required.…”

“…Hepatocellular carcinoma (HCC) is the most prevalent type of primary liver cancer[ 1 ]. It is the third most common cause of cancer-related deaths worldwide and has the fifth-highest incidence rate of cancers[ 2 ]. Currently, most HCCs develop secondary to underlying liver disease, often due to chronic hepatitis B or C virus infection[ 3 ].…”