Lin Shuirong, Song Zimin, Peng Hong, Qian Baifeng, Lin Haozhong, Wu Xiwen, Li Huilong, Hua Yunpeng, Peng Baogang, Shang Changzhen, Kuang Ming, Shen Shunli
Center of Hepato-Pancreato-biliary Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
Center of Hepato-Pancreato-biliary Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China; Department of Clinical Nutrition, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, China.
Surgery. 2023 Oct;174(4):865-873. doi: 10.1016/j.surg.2023.06.025. Epub 2023 Jul 29.
Posthepatectomy liver failure is one of the main causes of death in patients after hepatectomy. This study intends to establish a prediction model to predict the risk of posthepatectomy liver failure and provide a scientific basis for further reducing the incidence of posthepatectomy liver failure.
This was a retrospective analysis of 1,172 patients with hepatocellular carcinoma undergoing partial hepatectomy. Using univariate and multivariate logistic regression analyses and stepwise regression, a prediction model for posthepatectomy liver failure was established based on the independent risk factors for posthepatectomy liver failure and validated by bootstrapping with 100 resamples, and the receiver operating characteristic curve was used to evaluate the predictive value of the prediction model.
The incidence rate of posthepatectomy liver failure was 22.7% (266/1172). The results showed that the indocyanine green retention rate at 15 minutes (odds ratio = 1.05, P = .002), alanine transaminase (odds ratio = 1.02, P < .001), albumin rate (odds ratio = 0.92, P < .001), total bilirubin (odds ratio = 1.04, P < .001), prothrombin time (odds ratio = 2.44, P < .001), aspartate aminotransferase-neutrophil ratio (odds ratio = 0.95, P < .001), and liver fibrosis index (odds ratio = 1.35, P < .001) were associated with posthepatectomy liver failure. These 7 independent risk factors for posthepatectomy liver failure were integrated into a nomogram prediction model, the predictive efficiency for posthepatectomy liver failure (area under the curve = 0.818, 95% confidence interval 0.789-0.848) was significantly higher than in other predictive models with a liver fibrosis index (area under the curve = 0.651), indocyanine green R15 (area under the curve = 0.669), albumin-bilirubin score (area under the curve = 0.709), albumin-indocyanine green evaluation score (area under the curve = 0.706), model for end-stage liver disease score (area under the curve = 0.636), and Child‒Pugh (area under the curve = 0.551) (all P < .001). The risk of posthepatectomy liver failure in the high-risk posthepatectomy liver failure group (score ≥152) was higher than that in the posthepatectomy liver failure low-risk group (score <152).
This study developed and validated a nomogram model to predict the risk of posthepatectomy liver failure before surgery that can effectively predict the risk of posthepatectomy liver failure in patients with hepatocellular carcinoma.
肝切除术后肝衰竭是肝切除术后患者死亡的主要原因之一。本研究旨在建立一个预测模型，以预测肝切除术后肝衰竭的风险，并为进一步降低肝切除术后肝衰竭的发生率提供科学依据。
这是一项对1172例行肝部分切除术的肝细胞癌患者的回顾性分析。采用单因素和多因素逻辑回归分析及逐步回归法，基于肝切除术后肝衰竭的独立危险因素建立肝切除术后肝衰竭预测模型，并通过100次重复抽样的自举法进行验证，采用受试者工作特征曲线评估预测模型的预测价值。
肝切除术后肝衰竭的发生率为22.7%（266/1172）。结果显示，15分钟吲哚菁绿滞留率（比值比=1.05，P=0.002）、丙氨酸转氨酶（比值比=1.02，P<0.001）、白蛋白率（比值比=0.92，P<0.001）、总胆红素（比值比=1.04，P<0.001）、凝血酶原时间（比值比=2.44，P<0.001）、天冬氨酸转氨酶-中性粒细胞比值（比值比=0.95，P<0.001）和肝纤维化指数（比值比=1.35，P<0.001）与肝切除术后肝衰竭相关。将这7个肝切除术后肝衰竭的独立危险因素整合到一个列线图预测模型中，该模型对肝切除术后肝衰竭的预测效率（曲线下面积=0.818，95%置信区间0.789-0.848）显著高于其他具有肝纤维化指数（曲线下面积=0.651）、吲哚菁绿R15（曲线下面积=0.669）、白蛋白-胆红素评分（曲线下面积=0.709）、白蛋白-吲哚菁绿评估评分（曲线下面积=0.706）、终末期肝病模型评分（曲线下面积=0.636）和Child-Pugh评分（曲线下面积=0.551）的预测模型（所有P<0.001）。肝切除术后肝衰竭高危组（评分≥152）肝切除术后肝衰竭的风险高于肝切除术后肝衰竭低危组（评分<152）。
本研究开发并验证了一种术前预测肝切除术后肝衰竭风险的列线图模型，该模型可有效预测肝细胞癌患者肝切除术后肝衰竭的风险。
