A novel model for predicting posthepatectomy liver failure in patients with hepatocellular carcinoma.

Wei Peng,Jia-Wu Li,Tian-Fu Wen,Chuan Li,Xiao-Yun Zhang,Lv-Nan Yan,Jia-Yin Yang,Chun Chieh Yeh

doi:10.1371/journal.pone.0219219

Abstract

Posthepatectomy liver failure (PHLF) is the most leading cause of mortality following hepatectomy in patients with hepatocellular carcinoma (HCC). Platelet count was reported to be a simple but useful indicator of liver cirrhosis and function of spleen. Spleen stiffness (SS) was used to evaluate the morphological change of spleen and was reported to be related to liver cirrhosis and portal hypertension. However, the predictive value of platelet to spleen stiffness ratio (PSR) on PHLF remains unknown. A retrospective study was performed to analyze 158 patients with HCC following hepatectomy from August 2015 to February 2016. Univariate and multivariate analyses were performed to evaluate the value of each risk factor for predicting PHLF. The predictive efficiency of the risk factors was evaluated by receiver operating characteristic (ROC) curve. PHLF occured in 23 (14.6%) patients. PSR (P<0.001, odds ratio (OR) = 0.622, 95% confidence interval (CI) 0.493~0.784), hepatic inflow occlusion (HIO) (P = 0.003, OR = 1.044, 95% CI 1.015~1.075) and major hepatectomy (P = 0.019, OR = 5.967, 95% CI 1.346~26.443) were demonstrated to be the independent predictive factors for development of PHLF in a multivariate analysis. Results of the present study suggested PSR is a novel and non-invasive model for predicting PHLF in patients with HCC.

Highlights

Hepatocellular carcinoma (HCC) is one of the most common malignancies and is the third leading cause of cancer related deaths worldwide[1]
Univariate analysis suggested that tumor diameter, liver cirrhosis, SS, platelet to spleen stiffness ratio (PSR), operation duration, hepatic inflow occlusion (HIO), major hepatectomy and intraoperative transfusion were significantly related to development of posthepatectomy liver failure (PHLF) (Table 1)
Multivariate analysis demonstrated that PSR (P

Summary

Introduction

Hepatocellular carcinoma (HCC) is one of the most common malignancies and is the third leading cause of cancer related deaths worldwide[1]. The predominant risk factor for HCC is chronic infection of hepatitis B virus (HBV) in China[2]. More than half of the new cases and deaths occurred in China because of the high prevalence of HBV[3]. Hepatectomy is widely accepted as a curative treatment for HCC patients even though liver transplantation is the ideal treatment[4]. The reported incidence of posthepatectomy liver failure (PHLF) is as high as 12% according to the definition by International Study Group of Liver Surgery (ISGLS)[5]. Continuous effort to identify risk factors for development of PHLF remains necessary

Methods

Results

Conclusion