Relevance of liver surface nodularity for preoperative risk assessment in patients with resectable hepatocellular carcinoma

Abstract

Background: Quantification of liver surface nodularity (LSN) on routine preoperative CT images allows detection of cirrhosis and clinically significant portal hypertension. This study aimed to assess the relevance of LSN in preoperative assessment of operative risks for patients with resectable hepatocellular carcinoma (HCC).Methods: All patients undergoing hepatectomy for HCC between 2012 and 2017 were analysed retrospectively. LSN was assessed at the liver-fat interface on the left liver lobe on preoperative CT images. The feasibility of LSN quantification was assessed. The association between LSN and outcomes (severe complications and posthepatectomy liver failure (PHLF)) was evaluated by multivariable analysis and after propensity score matching.Results: Among 210 patients, LSN measurement was successful in 187 (89⋅0 per cent). Among these, the median LSN score was 2⋅42 (i.q.r. 2⋅21-2⋅66) and 52⋅9 per cent had severe fibrosis, including 33⋅7 per cent with cirrhosis. LSN score increased with hepatic venous pressure gradient (P = 0⋅048), severity of steatosis (P = 0⋅011) and fibrosis grade (P = 0⋅001). LSN score was independently associated with severe complications (odds ratio (OR) 5⋅25; P = 0⋅006) and PHLF (OR 6⋅78; P = 0⋅003). After matching with respect to model for end-stage liver disease, aspartate aminotransferase-to-platelet ratio index and fibrosis-4 score, patients with a LSN score of 2⋅63 or higher retained an increased risk of PHLF (OR 5⋅81; P = 0⋅018). In the subgroup of patients without severe fibrosis, LSN was accurate in predicting severe complications (P = 0⋅005). Patients with (P = 0⋅039) or without (P = 0⋅018) severe fibrosis with increased LSN score had a higher comprehensive complication index score. Among patients with cirrhosis who had clinically significant portal hypertension, a LSN value below 2⋅63 ruled out the risk of PHLF. Conclusion: LSN measurement represents a practical tool that may allow improvement in the preoperative evaluation and management of patients with HCC. Preoperative biopsy of the underlying liver and hepatic venous pressure gradient (HVPG) measurement represent the standard in the evaluation of parenchymal changes and clinically significant portal hypertension (CSPH). Yet, Reference 1 Takemura N, Aoki T, Hasegawa K, Kaneko J, Arita J, Akamatsu N et al. Hepatectomy for hepatocellular carcinoma after perioperative management of portal hypertension.

Influence of surgical approach and quality of resection on the probability of cure for early-stage HCC occurring in cirrhosis

“…This means that less than half of HCC patients experienced an ideal outcome following LR, and emphasises that HCC patients are likely to develop postoperative complications related to underlying cirrhosis. 33,34 This study highlights the pivotal prognostic role of having an ideal outcome following LR. All TO criteria are separately acknowledged to influence the prognosis of HCC patients.…”

Similar performance of liver stiffness measurement and liver surface nodularity for the detection of portal hypertension in patients with hepatocellular carcinoma

“…Noticeably, our group recently showed that the preoperative LSN value was associated with severe complications, postoperative liver failure, and clinically significant postoperative liver failure in patients with HCC undergoing resection. 27 In addition, there was no external validation cohort. Nevertheless, our study further validates the results of Sartoris et al 10 Finally, no sample size calculation was performed.…”

HCC advances in diagnosis and prognosis: Digital and Imaging

“…Its performance as also found to be similar to LSM in patients with HCC with a two‐step algorithm combining LSN and LSPS, resulting in accurate detection of clinically‐significant portal hypertension in more than 75% of patients 26 . Finally, this simple quantitative biomarker was shown to be a practical tool for the assessment of preoperative risk in patients with resectable HCC, with a better performance than the usual liver function tests such as the MELD score, APRI and FIB‐4 score 27 . As for radiomics, LSN measurement is retrospectively performed on routine cross‐sectional images, making it easier to transfer these results from research to clinical reality.…”