Shirata Chikara, Kokudo Takashi, Arita Junichi, Akamatsu Nobuhisa, Kaneko Junichi, Sakamoto Yoshihiro, Kokudo Norihiro, Hasegawa Kiyoshi
Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan.
Hepatol Res. 2019 Aug;49(8):942-949. doi: 10.1111/hepr.13327. Epub 2019 Apr 7.
The aim of this study was to evaluate the role of liver function factors in predicting a postoperative large-volume ascites (LA) and post-hepatectomy liver failure (PHLF).
We included 1025 consecutive patients undergoing hepatectomy for hepatocellular carcinoma between 2002 and 2014. Univariate and multivariate analyses were carried out to evaluate the role of each factor of liver function in predicting LA and PHLF. Factors included the presence of portal hypertension (PH), extent of resection, Model for End-stage Liver Disease (MELD) score, and Albumin-Indocyanine Green Evaluation (ALICE) grade.
The ALICE score was the strongest predictor for LA (odds ratio [OR], 5.02) and PHLF (OR, 10.94). Conversely, MELD score was not a significant predictive factor for LA or PHLF based on the multivariate analysis. In the ALICE grade 2 group, patients with PH showed a significantly high incidence of developing LA and experiencing PHLF compared with those without PH (LA, 22.4% vs. 10.3%, P < 0.001; PHLF, 8.6% vs. 1.3%, P < 0.001, respectively). Of patients in the ALICE 2 group, those undergoing sectoriectomy or more extensive resection were associated with extremely poor outcomes (LA, 54.2%; PHLF, 29.2%).
A combination of ALICE grade and presence of PH is a useful predictor of LA and PHLF.
本研究旨在评估肝功能因素在预测术后大量腹水（LA）和肝切除术后肝功能衰竭（PHLF）中的作用。
我们纳入了2002年至2014年间连续1025例行肝细胞癌肝切除术的患者。进行单因素和多因素分析以评估肝功能各因素在预测LA和PHLF中的作用。因素包括门静脉高压（PH）的存在、切除范围、终末期肝病模型（MELD）评分和白蛋白-吲哚菁绿评估（ALICE）分级。
ALICE评分是LA（比值比[OR]，5.02）和PHLF（OR，10.94）的最强预测因子。相反，基于多因素分析，MELD评分不是LA或PHLF的显著预测因子。在ALICE 2级组中，与无PH的患者相比，有PH的患者发生LA和发生PHLF的发生率显著更高（LA，22.4%对10.3%，P<0.001；PHLF，8.6%对1.3%，P<0.001）。在ALICE 2级组患者中，接受扇形切除或更广泛切除的患者预后极差（LA，54.2%；PHLF，29.2%）。
ALICE分级和PH的存在相结合是LA和PHLF的有用预测指标。
