Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
J Am Coll Surg. 2013 Feb;216(2):201-9. doi: 10.1016/j.jamcollsurg.2012.10.018. Epub 2012 Dec 7.
Standardized future liver remnant (sFLR) volume and degree of hypertrophy after portal vein embolization (PVE) have been recognized as important predictors of surgical outcomes after major liver resection. However, the regeneration rate of the FLR after PVE varies among individuals and its clinical significance is unknown.
Kinetic growth rate (KGR) is defined as the degree of hypertrophy at initial volume assessment divided by number of weeks elapsed after PVE. In 107 consecutive patients who underwent liver resection for colorectal liver metastases with an sFLR volume >20%, the ability of the KGR to predict overall and liver-specific postoperative morbidity and mortality was compared with sFLR volume and degree of hypertrophy.
Using receiver operating characteristic analysis, the best cutoff values for sFLR volume, degree of hypertrophy, and KGR for predicting postoperative hepatic insufficiency were estimated as 29.6%, 7.5%, and 2.0% per week, respectively. Among these, KGR was the most accurate predictor (area under the curve 0.830 [95% CI, 0.736-0.923]; asymptotic significance, 0.002). A KGR of <2% per week vs ≥2% per week correlates with rates of hepatic insufficiency (21.6% vs 0%; p = 0.0001) and liver-related 90-day mortality (8.1% vs 0%; p = 0.04). The predictive value of KGR was not influenced by sFLR volume or the timing of initial volume assessment when evaluated within 8 weeks after PVE.
Kinetic growth rate is a better predictor of postoperative morbidity and mortality after liver resection for small FLR than conventional measured volume parameters (ie, sFLR volume and degree of hypertrophy).
标准的未来肝脏残余量（sFLR）体积和门静脉栓塞（PVE）后的肝体积增生程度已被认为是肝切除术后手术结果的重要预测指标。然而，PVE 后 FLR 的再生率在个体之间存在差异，其临床意义尚不清楚。
动力学生长率（KGR）定义为初始体积评估时的肝体积增生程度除以 PVE 后经过的周数。在 107 例连续接受 sFLR 体积>20%的结直肠癌肝转移行肝切除术的患者中，将 KGR 预测总体和肝特异性术后发病率和死亡率的能力与 sFLR 体积和增生程度进行比较。
使用受试者工作特征分析，估计预测术后肝衰竭的 sFLR 体积、增生程度和 KGR 的最佳截断值分别为 29.6%、7.5%和 2.0%/周。在这些指标中，KGR 是最准确的预测指标（曲线下面积 0.830[95%CI，0.736-0.923]；渐近显著性，0.002）。KGR<2%/周与≥2%/周的肝衰竭发生率（21.6%与 0%；p=0.0001）和与肝脏相关的 90 天死亡率（8.1%与 0%；p=0.04）相关。当在 PVE 后 8 周内评估时，KGR 的预测价值不受 sFLR 体积或初始体积评估时间的影响。
与传统的测量体积参数（即 sFLR 体积和增生程度）相比，动力学生长率是预测小 FLR 肝切除术后发病率和死亡率的更好指标。
