Division of Interventional Ultrasound, Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, No.58 Zhong Shan Road 2, Guangzhou, 510080, China.
Department of Ultrasonography, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China.
Eur Radiol. 2023 Nov;33(11):7665-7674. doi: 10.1007/s00330-023-09803-w. Epub 2023 Jun 14.
To develop and validate a nomogram based on liver stiffness (LS) for predicting symptomatic post-hepatectomy (PHLF) in patients with hepatocellular carcinoma (HCC).
A total of 266 patients with HCC were enrolled prospectively from three tertiary referral hospitals from August 2018 to April 2021. All patients underwent preoperative laboratory examination to obtain parameters of liver function. Two-dimensional shear wave elastography (2D-SWE) was performed to measure LS. Three-dimensional virtual resection obtained the different volumes including future liver remnant (FLR). A nomogram was developed by using logistic regression and determined by receiver operating characteristic (ROC) curve analysis and calibration curve analysis, which was validated internally and externally.
A nomogram was constructed with the following variables: FLR ratio (FLR of total liver volume), LS greater than 9.5 kPa, Child-Pugh grade, and the presence of clinically significant portal hypertension (CSPH). This nomogram enabled differentiation of symptomatic PHLF in the derivation cohort (area under curve [AUC], 0.915), internal fivefold cross-validation (mean AUC, 0.918), internal validation cohort (AUC, 0.876) and external validation cohort (AUC, 0.845). The nomogram also showed good calibration in the derivation, internal validation, and external validation cohorts (Hosmer-Lemeshow goodness-of-fit test, p = 0.641, p = 0.06, and p = 0.127, respectively). Accordingly, the safe limit of the FLR ratio was stratified using the nomogram.
An elevated level of LS was associated with the occurrence of symptomatic PHLF in HCC. A preoperative nomogram integrating LS, clinical and volumetric features was useful in predicting postoperative outcomes in patients with HCC, which might help surgeons in the management of HCC resection.
A serial of the safe limit of the future liver remnant was proposed by a preoperative nomogram for hepatocellular carcinoma, which might help surgeons in 'how much remnant is enough in liver resection'.
• An elevated liver stiffness with the best cutoff value of 9.5 kPa was associated with the occurrence of symptomatic post-hepatectomy liver failure in hepatocellular carcinoma. • A nomogram based on both quality (Child-Pugh grade, liver stiffness, and portal hypertension) and quantity of future liver remnant was developed to predict symptomatic post-hepatectomy liver failure for HCC, which enabled good discrimination and calibration in both derivation and validation cohorts. • The safe limit of future liver remnant volume was stratified using the proposed nomogram, which might help surgeons in the management of HCC resection.
建立并验证基于肝硬度（LS）的列线图预测肝细胞癌（HCC）患者肝切除术后（PHLF）症状性的模型。
前瞻性纳入 2018 年 8 月至 2021 年 4 月期间三家三级转诊医院的 266 例 HCC 患者。所有患者均接受术前实验室检查以获得肝功能参数。采用二维剪切波弹性成像（2D-SWE）测量 LS。通过三维虚拟切除获得不同的体积，包括剩余肝体积（FLR）。使用逻辑回归建立列线图，并通过受试者工作特征（ROC）曲线分析和校准曲线分析进行验证，通过内部和外部验证进行验证。
建立了一个列线图，包含以下变量：FLR 比率（FLR 占总肝体积的比例）、LS 大于 9.5kPa、Child-Pugh 分级和临床显著门脉高压（CSPH）的存在。该列线图能够区分研究队列中症状性 PHLF（曲线下面积[AUC]，0.915）、内部五分位交叉验证（平均 AUC，0.918）、内部验证队列（AUC，0.876）和外部验证队列（AUC，0.845）。该列线图在推导、内部验证和外部验证队列中也显示出良好的校准（Hosmer-Lemeshow 拟合优度检验，p=0.641、p=0.06 和 p=0.127）。因此，使用该列线图对 FLR 比率的安全限进行分层。
LS 水平升高与 HCC 患者发生症状性 PHLF 有关。术前整合 LS、临床和体积特征的列线图有助于预测 HCC 患者的术后结局，可能有助于外科医生进行 HCC 切除术的管理。
通过术前列线图提出了一系列剩余肝的安全限，这可能有助于外科医生在肝切除术中“保留多少肝才算足够”的问题上。
最佳截断值为 9.5kPa 的升高的肝硬度与肝细胞癌中发生症状性肝切除术后肝衰竭有关。
建立了一个基于剩余肝质量（Child-Pugh 分级、肝硬度和门脉高压）和数量的列线图来预测 HCC 患者的症状性肝切除术后肝衰竭，该列线图在推导和验证队列中均具有良好的区分度和校准度。
使用提出的列线图对剩余肝体积的安全限进行分层，这可能有助于外科医生进行 HCC 切除术的管理。
