A Nomogram Based on Preoperative Inflammatory Indices and ICG-R15 for Prediction of Liver Failure After Hepatectomy in HCC Patients

Fang, Tongdi; Long, Guo; Wang, Dong; Li, Xudong; Liang, Xiao; Mi, Xingyu; Su, Wenxin; Zhou, Lingxiao; Zhou, Ledu

doi:10.3389/fonc.2021.667496

Cited by 10 publications

(9 citation statements)

References 41 publications

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“…The 90-day mortality rate in patients with PHLF was 9.1% when compared with 0% in patients without PHLF. Although previous studies on HBV-DNA level, ICG-R15, and PT have been reported to predict PHLF (44,45), our results demonstrated the degree of cirrhosis as assessed by our reported pre-operative CSS was an additional and significant independent predictor for PHLF. Among the factors which were found in our study to be strongly correlated with PHLF, pre-operative CSS and intra-operative DSM were the most significant predictors (all P<0.001).…”

Section: Discussioncontrasting

confidence: 79%

A combined pre- and intra-operative nomogram in evaluation of degrees of liver cirrhosis predicts post-hepatectomy liver failure: a multicenter prospective study

Liang¹,

Zhang²,

Li³

et al. 2024

Hepatobiliary Surg Nutr

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Background: Adequate evaluation of degrees of liver cirrhosis is essential in surgical treatment of hepatocellular carcinoma (HCC) patients. The impact of the degrees of cirrhosis on prediction of posthepatectomy liver failure (PHLF) remains poorly defined. This study aimed to construct and validate a combined pre-and intra-operative nomogram based on the degrees of cirrhosis in predicting PHLF in HCC patients using prospective multi-center's data.Methods: Consecutive HCC patients who underwent hepatectomy between May 18, 2019 and Dec 19, 2020 were enrolled at five tertiary hospitals. Preoperative cirrhotic severity scoring (CSS) and intra-operative direct liver stiffness measurement (DSM) were performed to correlate with the Laennec histopathological grading system. The performances of the pre-operative nomogram and combined pre-and intra-operative nomogram in predicting PHLF were compared with conventional predictive models of PHLF.Results: For 327 patients in this study, histopathological studies showed the rates of HCC patients with no, mild, moderate, and severe cirrhosis were 41.9%, 29.1%, 22.9%, and 6.1%, respectively. Either CSS or DSM was closely correlated with histopathological stages of cirrhosis. Thirty-three (10.1%) patients developed PHLF. The 30-and 90-day mortality rates were 0.9%. Multivariate regression analysis showed four preoperative variables [HBV-DNA level, ICG-R15, prothrombin time (PT), and CSS], and one intra-operative variable (DSM) to be independent risk factors of PHLF. The pre-operative nomogram was constructed based Highlight box Key findings• Four pre-operative variables (HBV-DNA level, ICG-R15, prothrombin time, and CSS), and one intra-operative variable (DSM) were independent risk factors of post-hepatectomy liver failure (PHLF). • Both the pre-operative nomogram and the combined pre-and intra-operative nomogram were efficient in predicting PHLF. What is known and what is new?• What is known: Adequate evaluation of degrees of liver cirrhosis is essential in surgical treatment of HCC patients. • What is new: This study constructed and validated a combined pre-and intra-operative nomogram based on the degrees of cirrhosis in predicting PHLF in HCC patients. What is the implication, and what should change now?• The pre-operative model should be used pre-operatively to identify individuals who are at high risks of developing PHLF. The combined pre-and intra-operative model should be used to make a final decision on whether to continue with hepatectomy or to carry out a lesser extent of hepatectomy.on these four pre-operative variables together with total bilirubin. The combined pre-and intra-operative nomogram was constructed by adding the intra-operative DSM. The pre-operative nomogram was better than the conventional models in predicting PHLF. The prediction was further improved with the combined pre-and intra-operative nomogram. Conclusions:The combined pre-and intra-operative nomogram further improved prediction of PHLF when compared with the pre-operative nomogram.

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Section: Discussioncontrasting

confidence: 79%

A combined pre- and intra-operative nomogram in evaluation of degrees of liver cirrhosis predicts post-hepatectomy liver failure: a multicenter prospective study

Liang¹,

Zhang²,

Li³

et al. 2024

Hepatobiliary Surg Nutr

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“…However, it only included patients with HCC (diameter ≥ 10 cm), and its inclusion of intraoperative blood loss could not provide an accurate prediction of PHLF preoperatively. The nomogram constructed by Fang incorporates cirrhosis, but its assessment of cirrhosis is based on imaging evaluation rather than histologically confirmed ( 27 ). Therefore it is less accurate for the diagnosis of early occult cirrhosis, while its inclusion of intraoperative blood loss, like that of Xu, makes it difficult to assess PHLF preoperatively.…”

Section: Discussionmentioning

confidence: 99%

Developing and validating a nomogram based on skeletal muscle index and clinical scoring system for prediction of liver failure after hepatectomy

et al. 2023

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Background and objectivesHepatectomy is the preferred treatment for patients with liver tumors. Post-hepatectomy liver failure (PHLF) remains one of the most fatal postoperative complications. We aim to explore the risk factors of PHLF and create a nomogram for early prediction of PHLF.MethodsWe retrospectively analyzed patients undergoing hepatectomy at the Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University between 2015 and 2022, and the patients were divided into training and internal validation cohorts at an 8:2 ratio randomly. The patients undergoing liver resection from the Affiliated Huaian Hospital of Xuzhou Medical University worked as external validation. Then, a nomogram was developed which was based on multivariate analyses to calculate the risk of PHLF. The area under the ROC curve (AUROC) and Hosmer -Lemeshow test was used to evaluate the prediction effect of the model.ResultsA total of 421 eligible patients were included in our study. Four preoperative variables were identified after multivariate analysis as follows, ASA (American Society of Anesthesiologists) score, Child-Pugh score, SMI (Skeletal muscle index), and MELD (Model for end-stage liver disease) score as independent predictors of PHLF. The area under the ROC curve of the predictive model in the training, internal, and external validation cohorts were 0.89, 0.82, and 0.89. Hosmer -Lemeshow P values in the training, internal, and external validation cohorts were 0.91, 0.22, and 0.15. The Calibration curve confirmed that our nomogram prediction results were in accurate agreement with the actual occurrence of PHLF.ConclusionWe construct a nomogram to predict the grade B/C PHLF of ISGLS (International Study Group of Liver Surgery) in patients who underwent hepatic resection based on risk factors. This tool can provide a visual and accurate preoperative prediction of the grade B/C PHLF and guide the next step of clinical decision-making.

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“…Previously, several models were established to predict PHLF but exhibited obvious heterogeneity. Some nomograms were derived from data of patients with benign and malignant lesions ( 15 ), while some nomograms incorporated both preoperative and intraoperative variables ( 15 , 25 ), and some nomograms were based on analysis of both minor and major hepatectomies ( 17 , 18 , 26 ). Recently, Chin and colleagues ( 27 ) created a PHLF prognostic nomogram for major hepatectomy; however, the study involved patients with either HCC or colorectal liver metastasis.…”

Section: Discussionmentioning

confidence: 99%

A Novel Nomogram for Predicting Postoperative Liver Failure After Major Hepatectomy for Hepatocellular Carcinoma

Lei

Cheng

et al. 2022

Front. Oncol.

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BackgroundPost-hepatectomy liver failure (PHLF) is the most common cause of mortality after major hepatectomy in hepatocellular carcinoma (HCC) patients. We aim to develop a nomogram to preoperatively predict grade B/C PHLF defined by the International Study Group on Liver Surgery Grading (ISGLS) in HCC patients undergoing major hepatectomy.Study DesignThe consecutive HCC patients who underwent major hepatectomy at the Eastern Hepatobiliary Surgery Hospital between 2008 and 2013 served as a training cohort to develop a preoperative nomogram, and patients from 2 other hospitals comprised an external validation cohort. Least absolute shrinkage and selection operator (LASSO) logistic regression was applied to identify preoperative predictors of grade B/C PHLF. Multivariable logistic regression was utilized to establish a nomogram model. Internal and external validations were used to verify the performance of the nomogram. The accuracy of the nomogram was also compared with the conventional scoring models, including MELD and ALBI score.ResultsA total of 880 patients who underwent major hepatectomy (668 in the training cohort and 192 in the validation cohort) were enrolled in this study. The independent risk factors of grade B/C PHLF were age, gender, prothrombin time, total bilirubin, and CSPH, which were incorporated into the nomogram. Good prediction discrimination was achieved in the training (AUROC: 0.73) and validation (AUROC: 0.72) cohorts. The calibration curve also showed good agreement in both training and validation cohorts. The nomogram has a better performance than MELD and ALBI score models.ConclusionThe proposed nomogram showed more accurate ability to individually predict grade B/C PHLF after major hepatectomy in HCC patients than MELD and ALBI scores.

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A Nomogram Based on Preoperative Inflammatory Indices and ICG-R15 for Prediction of Liver Failure After Hepatectomy in HCC Patients

Cited by 10 publications

References 41 publications

A combined pre- and intra-operative nomogram in evaluation of degrees of liver cirrhosis predicts post-hepatectomy liver failure: a multicenter prospective study

A combined pre- and intra-operative nomogram in evaluation of degrees of liver cirrhosis predicts post-hepatectomy liver failure: a multicenter prospective study

Developing and validating a nomogram based on skeletal muscle index and clinical scoring system for prediction of liver failure after hepatectomy

A Novel Nomogram for Predicting Postoperative Liver Failure After Major Hepatectomy for Hepatocellular Carcinoma

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