术前直接胆红素与凝血酶原时间比值指数预防小肝切除术后肝衰竭
Preoperative direct bilirubin to prothrombin time ratio index to prevent liver failure after minor hepatectomy.
作者信息
Furuyama Takaki, Kudo Atsushi, Matsumura Satoshi, Mitsunori Yusuke, Aihara Arihiro, Ban Daisuke, Ochiai Takanori, Tanaka Shinji, Tanabe Minoru
机构信息
Department of Hepato-Biliary-Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
Department of Molecular Oncology, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
出版信息
J Hepatobiliary Pancreat Sci. 2016 Dec;23(12):763-770. doi: 10.1002/jhbp.400. Epub 2016 Oct 12.
BACKGROUND
The most reliable index to predict the safety of hepatectomy for patients with poor liver function remains unknown. We aimed to construct a novel preoperative index to predict early liver failure (ELF) and mortality due to recurrence-free liver failure (MLF) after hepatectomy.
METHODS
Between 2000 and 2012, 385 consecutive patients with hepatocellular carcinoma undergoing curative minor hepatectomy were divided into two sequential cohorts: training set (n = 143) and validation set (n = 242), and observed until 2015.
RESULTS
Prothrombin time and direct bilirubin were independent predictors of both ELF and MLF in the training set. Thus we devised a novel index, the direct bilirubin to prothrombin time ratio index (DBPTRI). The areas under ROC curves of DBPTRI for predicting ELF and MLF were 0.78 and 0.93, respectively, in the validation set. Using a preoperative DBPTRI cut off of 4.2, we accurately predicted ELF and MLF in 86.8% and 88.4% of patients, respectively. DBPTRI was the best predictor of ELF and MLF when compared with conventional indices such as ICG-R15 and Child-Pugh score. Moreover, the 5-year overall survival rates of the patients with low and high DBPTRI were 59% and 36%, respectively (P < 0.0001).
CONCLUSIONS
DBPTRI may serve as a simple, non-invasive index for estimating liver failure after hepatectomy.
背景
预测肝功能不良患者肝切除术安全性的最可靠指标尚不清楚。我们旨在构建一种新的术前指标，以预测肝切除术后早期肝衰竭（ELF）和无复发生存期肝衰竭（MLF）导致的死亡率。
方法
2000年至2012年期间，385例连续接受根治性小肝切除术的肝细胞癌患者被分为两个连续队列：训练集（n = 143）和验证集（n = 242），并观察至2015年。
结果
凝血酶原时间和直接胆红素是训练集中ELF和MLF的独立预测因素。因此，我们设计了一种新的指标，即直接胆红素与凝血酶原时间比值指数（DBPTRI）。在验证集中，DBPTRI预测ELF和MLF的ROC曲线下面积分别为0.78和0.93。使用术前DBPTRI临界值4.2，我们分别准确预测了86.8%和88.4%患者的ELF和MLF。与传统指标如ICG-R15和Child-Pugh评分相比，DBPTRI是ELF和MLF的最佳预测指标。此外，DBPTRI低和高的患者5年总生存率分别为59%和36%（P < 0.0001）。
结论
DBPTRI可作为评估肝切除术后肝衰竭的一种简单、非侵入性指标。
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