Predictors of Post-operative Liver Decompensation Events Following Resection in Patients with Cirrhosis and Hepatocellular Carcinoma: A Population-based Study

Abstract

Background: Appropriate patient selection for liver resection in hepatocellular carcinoma (HCC) is critical to mitigate major liver-related post-operative complications. Currently, no standard prognostic tool exists to predict the risk of POLDEs following partial hepatectomy in patients with cirrhosis and hepatocellular carcinoma. The objective of this study was to identify independent pre-operative predictors of post-operative liver decompensation events (POLDEs), for future development of prognostic tools to improve surgical decision-making. Method: This was a population-based, retrospective cohort study of patients with cirrhosis and incident HCC between 2007-2017, identified using administrative health data from Ontario, Canada. The occurrence of a POLDE or death within 2 years from surgery was described. Multivariable Cox regression identified independent predictors of POLDE-free survival, as well as cause-specific hazards for POLDEs and death. Results: Among 611 patients with cirrhosis and HCC who underwent liver resection, 160 (26.2%) experienced at least 1 POLDE and 189 (30.9%) died within 2 years of surgery. Presence of diabetes, hepatitis B cirrhosis etiology, major liver resection, and previous non-malignant decompensation were independent predictors of POLDE-free survival. Except extent of resection, the same risk factors were associated with POLDEs in cause-specific analysis. In contrast, only age and history of previous non-malignant decompensation were independent predictors of mortality. Conclusions: Among patients with cirrhosis undergoing resection for HCC, patient and disease-related factors are associated with POLDEs and POLDE-free survival. These factors can be used to both inform clinical practice and for the development of pre-operative prognostic tools, which may lead to improved outcomes in this population.