Abstract
(1) Introduction: Liver resection (LR) for hepatocellular carcinoma (HCC) is often burdened by life-threatening complications, such as post-hepatectomy liver failure (PHLF). The albumin-bilirubin (ALBI) score can accurately evaluate liver function and the long-term prognosis of HCC patients, including PHLF. We aimed to evaluate the diagnostic value of the ALBI grade in predicting PHLF in HCC patients undergoing LR. (2) Methods: MEDLINE, Embase, and Scopus were searched through January 17th, 2021. Studies reporting the ALBI grade and PHLF occurrence in HCC patients undergoing LR were included. The Odds Ratio (OR) prevalence with 95% confidence intervals (CI) was pooled, and the heterogeneity was expressed as I2. The quality of the studies was assessed using QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies). (3) Results: Seven studies met the inclusion criteria and were included in the analysis. A total of 5377 patients who underwent LR for HCC were considered, of whom 718 (13.4%) developed PHLF. Patients with ALBI grades 2 and 3 before LR showed increased rates of PHLF compared to ALBI grade 1 patients. The pooled OR was 2.572 (95% CI, 1.825 to 3.626, p < 0.001), with substantial heterogeneity between the studies (I2 = 69.6%) and no publication bias (Begg’s p = 0.764 and Egger’s p = 0.851 tests). All studies were at a ‘low risk’ or ‘unclear risk’ of bias. Univariate meta-regression analysis showed that heterogeneity was not dependent on the country of study, the age and sex of the participants, the definition of PHLF used, the rate of patients in Child–Pugh class A or undergoing major hepatectomy. (4) Conclusions: In this meta-analysis of published studies, individuals with ALBI grades of 2 and 3 showed increased rates of PHLF compared to ALBI grade 1 patients.
Highlights
Hepatocellular carcinoma (HCC) represents the second cause of cancer-related death worldwide [1]; in 90% of cases, it develops with underlying liver disease, leading to a relevant burden in morbidity and mortality in patients affected by chronic liver disease [2]
Six [26,27,30,34,47,48] were excluded from the meta-analysis due to insufficient data or no response by the study authors; five [28,35,46,49,50] studies were excluded since the reporting cohorts were already included or best characterized in more recent studies; one study [42] was not pertinent since it was performed on patients undergoing extrahepatic surgery; a further six studies [31,32,33,37,39,41] included large groups of patients undergoing liver resection (LR) for malignancies other than HCC and/or did not use the International Study Group of Liver Surgery (ISGLS) criteria [7] for post-hepatectomy liver failure (PHLF) diagnosis
PHLF represents a major event in patients undergoing LR and mostly affects patients with chronic liver disease complicated by HCC development [4]
Summary
Hepatocellular carcinoma (HCC) represents the second cause of cancer-related death worldwide [1]; in 90% of cases, it develops with underlying liver disease, leading to a relevant burden in morbidity and mortality in patients affected by chronic liver disease [2]. The current International Study Group of Liver Surgery (ISGLS) definition for PHLF represents the current standard method for its diagnosis [5,6], defined as an acquired deterioration of the liver functions characterized by an increased International Normalized Ratio (INR) and hyperbilirubinemia after postoperative day 5 [7]. An accurate pre-operative assessment of patients undergoing LR is required to overcome the PHLF risk, through the evaluation of liver function and the assessment of portal hypertension [8,9,10]. In Eastern countries a large use of the indocyanine green clearance (ICG) has been reported [12]
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