Abstract
The remnant liver's ability to regenerate may affect post-hepatectomy immediate mortality. The promotion of autophagy post-hepatectomy could enhance liver regeneration and reduce mortality. This study aimed to identify predictive factors of immediate mortality after surgical resection for hepatocellular carcinoma (HCC). A total of 535 consecutive HCC patients who had undergone their first surgical resection in Taiwan were enrolled between 2010 and 2014. Clinicopathological data and immediate mortality, defined as all cause-mortality within three months after surgery, were analyzed. The expression of autophagy proteins (LC3, Beclin-1, and p62) in adjacent non-tumor tissues was scored by immunohistochemical staining. Approximately 5% of patients had immediate mortality after surgery. The absence of LC3, hypoalbuminemia (<3.5 g/dl), high alanine aminotransferase, and major liver surgery were significantly associated with immediate mortality in univariate analyses. Multivariate logistic regression demonstrated that absence of LC3 (hazard ratio/95% confidence interval: 40.8/5.14-325) and hypoalbuminemia (2.88/1.11-7.52) were significantly associated with immediate mortality. The 3-month cumulative incidence of mortality was 12.1%, 13.0%, 21.4% and 0.4%, respectively, among patients with absence of LC3 expression, hypoalbuminemia, both, or neither of the two. In conclusion, the absence of LC3 expression in adjacent non-tumor tissues and hypoalbuminemia were strongly predictive of immediate mortality after resection for HCC.
Highlights
Patients with liver cirrhosis are at risk of developing hepatocellular carcinoma (HCC), and the severity of cirrhosis has an impact on post-hepatectomy-associated morbidity and mortality [1]
Liver resection (LR) is often considered the standard management for resectable HCC, and the severity of cirrhosis based on histological examination and the evaluation of hepatic functional reserve have been used as guidelines to distinguish patients suitable for curative LR [1,2,3]
We aimed to investigate the role of hepatic autophagy marker(s) present in the adjacent non-tumor (ANT) tissues in predicting mortality within three months after LR for HCC
Summary
Patients with liver cirrhosis are at risk of developing hepatocellular carcinoma (HCC), and the severity of cirrhosis has an impact on post-hepatectomy-associated morbidity and mortality [1]. Extended LR in patients with cirrhotic liver and staged LR are being applied as a means for curative resection and enhancement of long-term survival This compromises liver function and the small functional remnant liver volumes in these patients increases the risk of developing post-hepatectomy liver failure (PHLF) and mortality [8]. Several studies have reported that factors including the patient’s conditions, surgical management, and post-operative assessment may be used to predict PHLF and mortality [7, 8, 12,13,14,15,16] These factors are not consistent in predicting immediate mortality (IM), which is defined as death, regardless of cause, occurring within 3 months following LR. The identification of predictive factors of IM after surgical resection is of major clinical relevance and may serve as a promising strategy to decrease mortality among HCC patients
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