即刻术后 Fibrosis-4 指数可预测行根治性手术的肝细胞癌患者术后肝功能衰竭。

Immediate postoperative Fibrosis-4 predicts postoperative liver failure for patients with hepatocellular carcinoma undergoing curative surgery.

机构信息

Department of Hepato-Biliary-Pancreatic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, China.

Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.

出版信息

Dig Liver Dis. 2018 Jan;50(1):61-67. doi: 10.1016/j.dld.2017.09.127. Epub 2017 Oct 4.

DOI:10.1016/j.dld.2017.09.127

PMID:29054394

Abstract

BACKGROUND

Postoperative liver failure remains the main complication and predominant cause of hepatectomy-related mortality for patients undergoing liver resection.

AIM

Our aim is to investigate whether immediate postoperative Fibrosis-4 could predict postoperative liver failure.

METHODS

We retrospectively enrolled 1353 consecutive hepatocellular carcinoma patients undergoing radical resection. The characteristics and clinical outcomes were compared between patients with high and low immediate postoperative Fibrosis-4. Risk factors for hepatic failure were evaluated by univariate and multivariate analysis.

RESULTS

Using a receiver operating characteristic curve, immediate postoperative Fibrosis-4 showed good prediction ability for postoperative liver failure (AUROC=0.647, P<0.001). With the optimal cut-off value of 5.9, the high postoperative Fibrosis-4 group (Fibrosis-4<5.9) had higher postoperative complication (39.1% vs 28.6%, P<0.001), mortality (2.8% vs 0.6%, P<0.001) and liver failure (13.9% vs 6.2%, P<0.001). In addition, patients with high Fibrosis-4 had worse and delayed recovery of liver function. By univariate and multivariate analysis, Fibrosis-4, as well as liver removed volume, total bilirubin and albumin was identified as independent risk factor for postoperative liver failure.

CONCLUSIONS

Immediate postoperative Fibrosis-4 showed good prediction ability for postoperative liver failure, and required measure should be taken to prevent liver failure when high postoperative Fibrosis-4 appeared.

摘要

背景

术后肝功能衰竭仍然是肝癌患者行肝切除术后的主要并发症和主要死亡原因。

目的

本研究旨在探讨即刻术后 Fibrosis-4 是否可以预测术后肝功能衰竭。

方法

我们回顾性纳入了 1353 例连续行根治性肝切除术的肝细胞癌患者。比较了 Fibrosis-4 即刻术后高值和低值患者的特征和临床结局。采用单因素和多因素分析评估肝功能衰竭的危险因素。

结果

使用受试者工作特征曲线，即刻术后 Fibrosis-4 对术后肝功能衰竭具有良好的预测能力（AUROC=0.647，P<0.001）。最佳截断值为 5.9，高术后 Fibrosis-4 组（Fibrosis-4<5.9）术后并发症发生率（39.1% vs 28.6%，P<0.001）、死亡率（2.8% vs 0.6%，P<0.001）和肝功能衰竭发生率（13.9% vs 6.2%，P<0.001）更高。此外，Fibrosis-4 较高的患者肝功能恢复更差且延迟。单因素和多因素分析表明，Fibrosis-4 以及肝切除量、总胆红素和白蛋白是术后肝功能衰竭的独立危险因素。