Clinical value of the conventional liver function test in liver reserve function assessment for large hepatocellular carcinoma

Abstract

Objective To study the clinical value of the conventional liver function tests in liver reserve function assessment for large hepatocellular carcinoma. Methods The clinicopathological data of 113 patients with Child-Pugh A hepatocellular carcinoma who underwent radical resection with large hepatocellular carcinoma in the Department of Hepatobiliary Surgery of Fuzhou General Hospital of People′s Liberation Army from January 2014 to December 2016 were retrospectively analyzed. The patients were divided into two groups according to the recovery of postoperative liver function, which 105 patients recovered well and 8 patients had hepatic decompensation among them. The liver function index of two groups were analyzed. Measurement data with approximately normal distribution were represented by and groups were compared using t test; measurement data with skewed or uneven disstribution were represented by M (range)and group werecompared using Man-Whitney U test; count data were compared using Fisher exact test; risk factors for postoperative liver dysfunction were analyzed using Logistic single factor and multivariate and ROC curve were drawn. Results Preoperative prothrombin time, international standardization ratio, platelet, prealbumin, total bilirubin, alkaline phosphatase, γ-glutamyl transpeptidase comparison between the two groups were statistically significant (Z=-1.983, -2.180, -2.608, -2.007, -3.577, -2.228, -2.575, P<0.05). Logistic univariate analysis showed that platelet, total bilirubin and prealbumin were the risk factors for the recovery of liver function of radical resection hepatic decompensation with large hepatocellular carcinoma. Logistic multivariate regression analysis showed that preoperative high total bilirubin and low preabumin were independent risk factors of radical resection hepatic decompensation with large hepatocellular carcinoma. Logistic univariate analysis showed that preoperative high total bilirubin and low prealbumin were not risk factors of radical resection liver failure with large hepatocellular carcinoma. The area under the curve of total bilirubin was 0.880, P=0.000, 95%CI: 0.808-0.953, the sensitivity was 87.5%, specificity was 84.8% and the area under prealbumin curve was 0.769, P=0.011, 95%CI: 0.648-0.891, sensitivity was 75.2%, specificity was 77.5% by the ROC curve. The best threshold of total bilirubin and prealbumin after radical resection with large hepatocellular carcinoma were 17.55 μmol/L and 0.18 g/L respectively by the ROC curve. Conclusion The Child-Pugh A patients in radical resection hepatic decompensation with large hepatocellular carcinoma recover well when the preoperative liver function is as follows: total bilirubin<17.55 μmol/L and prealbumin≥0.18 g/L. Key words: Large hepatocellular carcinoma; Prealbumin; Hepatic reserve; Hepatic decompensation; Liver failure