Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, General Hospital, Vienna, Austria.
Department of Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, General Hospital, Vienna, Austria.
Ann Surg Oncol. 2024 Oct;31(10):6526-6536. doi: 10.1245/s10434-024-15618-w. Epub 2024 Jun 19.
Posthepatectomy liver failure (PHLF), complications of portal hypertension, and disease recurrence determine the outcome for hepatocellular carcinoma (HCC) patients undergoing liver resection. This study aimed to evaluate the von Willebrand factor antigen (vWF-Ag) as a non-invasive test for clinically significant portal hypertension (CSPH) and a predictive biomarker for time to recurrence (TTR) and overall survival (OS).
The study recruited 72 HCC patients with detailed preoperative workup from a prospective trial (NCT02118545) and followed for complications, TTR, and OS. Additionally, 163 compensated patients with resectable HCC were recruited to evaluate vWF-Ag cutoffs for ruling out or ruling in CSPH. Finally, vWF-Ag cutoffs were prospectively evaluated in an external validation cohort of 34 HCC patients undergoing liver resection.
In receiver operating characteristic (ROC) analyses, vWF-Ag (area under the curve [AUC], 0.828) was similarly predictive of PHLF as indocyanine green clearance (disappearance rate: AUC, 0.880; retention rate: AUC, 0.894), whereas computation of future liver remnant was inferior (AUC, 0.756). Cox-regression showed an association of vWF-Ag with TTR (per 10%: hazard ratio [HR], 1.056; 95% confidence interval [CI] 1.017-1.097) and OS (per 10%: HR, 1.067; 95% CI 1.022-1.113). In the analyses, VWF-Ag yielded an AUC of 0.824 for diagnosing CSPH, with a vWF-Ag of 182% or lower ruling out and higher than 291% ruling in CSPH. Therefore, a highest-risk group (> 291%, 9.7% of patients) with a 57.1% incidence of PHLF was identified, whereas no patient with a vWF-Ag of 182% or lower (52.7%) experienced PHLF. The predictive value of vWF-Ag for PHLF and OS was externally validated.
For patients with resectable HCC, VWF-Ag allows for simplified preoperative risk stratification. Patients with vWF-Ag levels higher than 291% might be considered for alternative treatments, whereas vWF-Ag levels of 182% or lower identify patients best suited for surgery.
肝癌患者行肝切除术后，肝衰竭（PHLF）、门静脉高压症（PHT）并发症和疾病复发决定了患者的预后。本研究旨在评估血管性血友病因子抗原（vWF-Ag）作为一种非侵入性的检测方法，用于诊断临床显著的门静脉高压症（CSPH），并作为预测复发时间（TTR）和总生存（OS）的生物标志物。
本研究从一项前瞻性试验（NCT02118545）中招募了 72 例肝癌患者，并进行了详细的术前检查，以评估并发症、TTR 和 OS。此外，招募了 163 例有可切除 HCC 的代偿性患者，以评估 vWF-Ag 临界值用于排除或诊断 CSPH。最后，前瞻性评估了 34 例肝癌患者行肝切除术后的外部验证队列中的 vWF-Ag 临界值。
在接受者操作特征（ROC）分析中，vWF-Ag（曲线下面积[AUC]，0.828）与吲哚菁绿清除率（消失率：AUC，0.880；保留率：AUC，0.894）同样可预测 PHLF，而计算剩余肝体积则较差（AUC，0.756）。Cox 回归显示 vWF-Ag 与 TTR（每增加 10%：风险比[HR]，1.056；95%置信区间[CI]，1.017-1.097）和 OS（每增加 10%：HR，1.067；95%CI，1.022-1.113）相关。在分析中，vWF-Ag 对 CSPH 的诊断 AUC 为 0.824，vWF-Ag 为 182%或更低排除 CSPH，高于 291%则诊断 CSPH。因此，确定了一个最高风险组（>291%，9.7%的患者），其 PHLF 发生率为 57.1%，而 vWF-Ag 为 182%或更低的患者（52.7%）没有发生 PHLF。vWF-Ag 对 PHLF 和 OS 的预测价值在外部得到验证。
对于可切除 HCC 患者，vWF-Ag 可简化术前风险分层。vWF-Ag 水平高于 291%的患者可能需要考虑替代治疗，而 vWF-Ag 水平为 182%或更低的患者则最适合手术治疗。
