Cucchetti Alessandro, Ercolani Giorgio, Vivarelli Marco, Cescon Matteo, Ravaioli Matteo, La Barba Giuliano, Zanello Matteo, Grazi Gian Luca, Pinna Antonio Daniele
Department of Surgery and Transplantation, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy.
Liver Transpl. 2006 Jun;12(6):966-71. doi: 10.1002/lt.20761.
The objective of this study was to predict postoperative liver failure and morbidity after hepatectomy for hepatocellular carcinoma (HCC) with cirrhosis. The model for end-stage liver disease (MELD) score is currently accepted as a disease severity index of cirrhotic patients awaiting liver transplantation; however, its impact on prognosis after resection of HCC on cirrhosis has never been investigated. One hundred fifty-four cirrhotic patients resected in a tertiary care setting for HCC were retrospectively analyzed. For each patient, the MELD score was calculated and related to postoperative liver failure and complications (morbidity). Hospital stay and 1-year survival was also investigated. MELD accuracy in predicting postoperative liver failure and morbidity of cirrhotic patients was assessed using receiver operating characteristic (ROC) analysis. Eleven patients (7.1%) experienced postoperative liver failure leading to death or transplantation. ROC analysis identified cirrhotic patients with a MELD score equal to or above 11 at high risk for postoperative liver failure (area under the curve [AUC] = 0.92, 95% confidence interval [CI] = 0.87-0.96; sensitivity = 82%; specificity = 89%). Forty-six patients (29.9%) developed at least 1 postoperative complication: ROC analysis identified patients with a MELD score equal to or above 9 at major risk for postoperative complications (AUC = 0.85, 95% CI = 0.78-0.89; sensitivity = 87%; specificity = 63%). Cirrhotic patients with MELD score below 9 had no postoperative liver failure and low morbidity (8.1%). In conclusion, the MELD score can accurately predict postoperative liver failure and morbidity of cirrhotic patients referred for resection of HCC and should be used to select the best candidates for hepatectomy.
本研究的目的是预测肝硬化肝细胞癌（HCC）肝切除术后的肝功能衰竭和发病率。终末期肝病模型（MELD）评分目前被公认为等待肝移植的肝硬化患者的疾病严重程度指标；然而，其对肝硬化HCC切除术后预后的影响从未被研究过。对在三级医疗机构接受HCC切除的154例肝硬化患者进行了回顾性分析。为每位患者计算MELD评分，并将其与术后肝功能衰竭和并发症（发病率）相关联。还调查了住院时间和1年生存率。使用受试者操作特征（ROC）分析评估MELD预测肝硬化患者术后肝功能衰竭和发病率的准确性。11例患者（7.1%）发生术后肝功能衰竭，导致死亡或移植。ROC分析确定MELD评分等于或高于11的肝硬化患者术后发生肝功能衰竭的风险较高（曲线下面积[AUC]=0.92，95%置信区间[CI]=0.87-0.96；敏感性=82%；特异性=89%）。46例患者（29.9%）发生至少1种术后并发症：ROC分析确定MELD评分等于或高于9的患者术后发生并发症的主要风险较高（AUC=0.85，95%CI=0.78-0.89；敏感性=87%；特异性=63%）。MELD评分低于9的肝硬化患者无术后肝功能衰竭且发病率较低（8.1%）。总之，MELD评分可以准确预测接受HCC切除的肝硬化患者的术后肝功能衰竭和发病率，应将其用于选择肝切除的最佳候选者。
