Department of Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Ann Surg Oncol. 2021 Aug;28(8):4227-4235. doi: 10.1245/s10434-020-09557-5. Epub 2021 Jan 15.
Hepatocellular carcinoma (HCC) is usually accompanied by different severities of cirrhosis, which is a risk factor for posthepatectomy liver failure (PHLF). Collagen proportional area (CPA) measurements can quantitatively determine the collagen contents of liver tissue. This study explored the impact of CPA on PHLF, and further investigated the correlation between CPA and a non-invasive method, namely cirrhotic severity scoring (CSS), previously proposed by our team.
A total of 224 HCC patients with Child-Pugh grade A liver function undergoing hepatectomy between 2017 and 2019 were retrospectively studied. Quantitative digital image analysis of resected liver tissues was used for the CPA measurement. Risk factors for PHLF were subjected to univariate and multivariate analyses, and the correlation between CPA and CSS was analyzed.
Overall, 28 (12.5%) patients experienced PHLF. Patients with PHLF had higher CPA values than those without PHLF (p < 0.001). Multivariate analysis showed CPA and extent of hepatectomy to be independent risk factors for PHLF. CPA values were divided into four stages based on their quartiles (C1: < 6.6%; C2: 6.6-10.7%; C3: 10.7-18.0%; C4: ≥ 18.0%). The incidence of PHLF increased with increasing CPA stages (p < 0.001). Furthermore, CSS was significantly correlated with CPA (r = 0.720; p < 0.001). The incidence of PHLF also increased with increasing severity of cirrhosis evaluated by CSS (p < 0.001).
In HCC patients with Child-Pugh grade A liver function, cirrhosis could be staged by liver collagen contents, which significantly influenced PHLF. Furthermore, CSS was useful in the preoperative evaluation of cirrhotic severity.
肝细胞癌（HCC）通常伴有不同程度的肝硬化，这是肝切除术后肝衰竭（PHLF）的一个危险因素。胶原比例面积（CPA）测量可定量确定肝组织的胶原含量。本研究探讨了 CPA 对 PHLF 的影响，并进一步研究了 CPA 与我们团队先前提出的一种非侵入性方法，即肝硬化严重程度评分（CSS）之间的相关性。
回顾性研究了 2017 年至 2019 年间 224 例肝功能 Child-Pugh 分级为 A 的 HCC 患者行肝切除术的情况。对切除的肝组织进行定量数字图像分析，用于 CPA 测量。对 PHLF 的危险因素进行单因素和多因素分析，并分析了 CPA 与 CSS 之间的相关性。
总体而言，28 例（12.5%）患者发生 PHLF。发生 PHLF 的患者的 CPA 值高于未发生 PHLF 的患者（p<0.001）。多因素分析显示，CPA 和肝切除范围是 PHLF 的独立危险因素。根据四分位数将 CPA 值分为四个阶段（C1：<6.6%；C2：6.6-10.7%；C3：10.7-18.0%；C4：≥18.0%）。随着 CPA 阶段的增加，PHLF 的发生率也随之增加（p<0.001）。此外，CSS 与 CPA 显著相关（r=0.720；p<0.001）。随着 CSS 评估的肝硬化严重程度增加，PHLF 的发生率也随之增加（p<0.001）。
在肝功能 Child-Pugh 分级为 A 的 HCC 患者中，肝硬化可以通过肝胶原含量进行分期，这显著影响 PHLF。此外，CSS 可用于术前评估肝硬化严重程度。
