Division of Surgical Oncology, Department of Surgery, SUNY Upstate Medical University, Syracuse, New York, USA.
Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska, USA.
J Surg Oncol. 2021 May;123(8):1750-1756. doi: 10.1002/jso.26463. Epub 2021 Mar 23.
Posthepatectomy liver failure (PHLF) is associated with significant morbidity and mortality. However, it is often difficult to predict the risk of PHLF in an individual patient. We aimed to develop a preoperative nomogram to predict PHLF and allow better risk stratification before surgery.
Data for patients undergoing a partial or major hepatectomy were extracted from the hepatectomy-specific NSQIP database for years 2014-2016. Data set from 2017 was used for validation. Patients with Grade B/C liver failure were compared with patients with no liver failure.
A total of 10 808 patients from 2014-2016 data set were included. Of these, 316 patients (2.9%) developed Grade B/C PHLF. In the multivariable model consisting of preoperative variables, the following were predictive of Grade B/C PHLF (all p < 0.05): male gender, biliary stent, neoadjuvant therapy, viral hepatitis B or C, concurrent resections, biliary reconstruction, low sodium, and low albumin (model c statistic-0.78). This model was used to construct a nomogram. In the 2017 validation cohort of 4367 patients the nomogram again demonstrated good c-statistic (0.78).
Our nomogram provides patient-specific probabilities for PHLF, and is easy to use. This is a valuable tool that can be utilized for preoperative patient counseling and selection.
肝切除术后肝功能衰竭（PHLF）与较高的发病率和死亡率相关。然而，通常难以预测个体患者发生 PHLF 的风险。我们旨在制定一种术前列线图来预测 PHLF，并在术前更好地进行风险分层。
从 2014-2016 年特定于肝切除术的 NSQIP 数据库中提取接受部分或大肝切除术的患者数据。2017 年的数据用于验证。将肝功能 B/C 级衰竭的患者与无肝功能衰竭的患者进行比较。
共纳入 2014-2016 年数据集的 10808 例患者。其中，316 例（2.9%）发生 B/C 级 PHLF。在由术前变量组成的多变量模型中，以下因素预测 B/C 级 PHLF（均 p<0.05）：男性、胆道支架、新辅助治疗、乙型或丙型病毒性肝炎、同时切除、胆道重建、低钠血症和低白蛋白血症（模型 c 统计量-0.78）。该模型用于构建列线图。在 2017 年的 4367 例验证队列中，该列线图再次显示出良好的 c 统计量（0.78）。
我们的列线图为 PHLF 提供了患者特异性概率，易于使用。这是一种有价值的工具，可用于术前患者咨询和选择。
