Abstract
BackgroundThe preoperative prediction of post hepatectomy liver failure (PHLF) is essential, but there is no gold standard for the prediction at present, and the efficacy of different methods for the prediction has not been compared systematically. In this study, we aimed to compare the efficacy of preoperative two-dimensional shear wave elastography (2D-SWE), indocyanine green (ICG) clearance test and biomarkers for PHLF prediction in patients with hepatocellular carcinoma (HCC).MethodsWe retrospectively studied 215 patients with HCC, who had undergone major liver resection in our hospital. Preoperative data of each patient, including liver stiffness value (LSV) of underlying hepatic parenchyma measured by 2D-SWE, ICG retention rate at 15 min (ICG-R15) measured by ICG clearance test, albumin-bilirubin (ALBI) scores, aspartate aminotransferase–platelet ratio index (APRI), and Fibrosis-4 (FIB-4) were collected for analysis. Post hepatectomy outcomes of study patients were also recorded for assessment of PHLF. The study patients were divided into development cohort (133 patients without PHLF, and 17 patients with PHLF) and validation cohort (59 patients without PHLF, and 6 patients with PHLF) randomly.ResultsIn the development cohort, LSV, ICG-R15 and ALBI scores were significantly different between patients with and without PHLF, while no significant difference of APRI and FIB-4 scores was found. LSV had higher AUC (the area under the receiver operating characteristic curve) (AUC = 0.795) for PHLF prediction than ICG-R15 (AUC = 0.619) and ALBI scores (AUC = 0.686) (p < 0.05 for all comparisons). In the validation cohort, the cutoff value of LSV obtained from the development cohort, 10.35 kPa, revealed higher specificity (76.3%) for PHLF prediction than ICG-R15 (specificity: 66.1%) and ALBI scores (specificity: 69.5%) (p < 0.0001).ConclusionsCompared with ICG-R15, ALBI scores, APRI and FIB-4, LSV measured by 2D-SWE may demonstrate better efficacy for preoperative PHLF prediction in patients with HCC.
Highlights
Liver resection is one of the main treatment options for hepatocellular carcinoma (HCC)
Compared with indocyanine green (ICG)-R15, ALBI scores, aminotransferase–platelet ratio index (APRI) and FIB-4, liver stiffness value (LSV) measured by Two-dimensional shear wave elastography (2D-SWE) may demonstrate better efficacy for preoperative post hepatectomy liver failure (PHLF) prediction in patients with HCC
The exclusion criteria were: (a) patients who underwent preoperative clinical intervention (n = 25), (b) patients with elevated level of total bilirubin (TB, normal range: 5.0–28.0 μmol/L) and/or evident elevated level of aspartate transaminase (AST, normal range: < 35 IU/L), or alanine transaminase (ALT, normal range: < 40 IU/L) (n = 11), (c) the volume of removed liver were less than 3 segements (n = 73), (d) patients who failed to estimate LSV by 2D-SWE (n = 1), (e) time interval between ICG clearance test, 2D-SWE examination and laboratory testing was more than 2 months (n = 9)
Summary
Liver resection is one of the main treatment options for hepatocellular carcinoma (HCC). Indocyanine green (ICG) clearance test is the most commonly used and is considered relatively reliable for liver function reserve assessment [3]. This method is not feasible in patients with an iodine allergy or thyrotoxicosis, because ICG contains iodine. The preoperative prediction of post hepatectomy liver failure (PHLF) is essential, but there is no gold standard for the prediction at present, and the efficacy of different methods for the prediction has not been compared systematically. We aimed to compare the efficacy of preoperative two-dimensional shear wave elastography (2D-SWE), indocyanine green (ICG) clearance test and biomarkers for PHLF prediction in patients with hepatocellular carcinoma (HCC)
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