A novel preoperative predictive model of 90-day mortality after liver resection for huge hepatocellular carcinoma

Abstract

Background: Hepatectomy for huge hepatocellular carcinoma (HCC) (diameter ≥10 cm) is characterized by high mortality. This study aimed to establish a preoperative model to evaluate the risk of postoperative 90-day mortality for huge HCC patients. Methods: We retrospectively enrolled 1,127 consecutive patients and prospectively enrolled 93 patients with huge HCC who underwent hepatectomy (training cohort, n=798; validation cohort, n=329; prospective cohort, n=93) in our institute. Based on independent preoperative predictors of 90-day mortality, we established a logistic regression model and visualized the model by nomogram.Results: The 90-day mortality rates were 9.6%, 9.2%, and 10.9% in the training, validation, and prospective cohort. The α-fetoprotein (AFP) level, the prealbumin levels, and the presence of portal vein tumor thrombosis (PVTT) were preoperative independent predictors of 90-day mortality. A logistic regression model, AFP-prealbumin-PVTT score (APP score), was subsequently established and showed good performance in predicting 90-day mortality (training cohort, AUC =0.87; validation cohort, AUC =0.91; prospective cohort, AUC =0.93). Using a cut-off of −1.96, the model could stratify patients into low risk (≤−1.96) and high risk (>−1.96) with different 90-day mortality rates (~30% vs. ~2%). Furthermore, the predictive performance for 90-day mortality and overall survival was significantly superior to the Child-Pugh score, the model of end-stage liver disease (MELD) score, and the albumin-bilirubin (ALBI) score. Conclusions:The APP score can precisely predict postoperative 90-day mortality as well as long-term survival for patients with huge HCC, assisting physician selection of suitable candidates for liver resection and improving the safety and efficacy of surgical treatment.

Preoperative Antiviral Therapy and Long-Term Outcomes for Hepatitis B Virus-Related Hepatocellular Carcinoma After Curative Liver Resection: A Multicenter Analysis

“… 31 Portal vein tumor thrombosis (PVTT) is an independent factor of 90-day mortality and long-term outcomes. 32 We excluded the HCC patients with PVTT due to the effect of preoperative antiviral therapy was easily overshadowed by the extremely high-risk factor. To explore the association between preoperative AVT and HBV DNA and long-term prognosis in patients with HCC who underwent liver resection, it may be more intuitive to further divide preoperative AVT and non-AVT patients into four groups based on the level of HBV DNA to demonstrate their potential relationship.…”

Prealbumin as a Predictor of Short-Term Prognosis in Patients with HBV-Related Acute-on-Chronic Liver Failure

“…13 In patients who have undergone hepatectomy or LT, serum prealbumin has been demonstrated to be a useful prognostic indicator for predicting postoperative complications and survival. 14,15 However, the potential utility of PAB in prognosticating HBV-ACLF has not been comprehensively investigated.…”

Efficacy and safety of drug-eluting bead transarterial chemoembolization (DEB-TACE) plus apatinib versus DEB-TACE alone in treating huge hepatocellular carcinoma patients

“…Huge hepatocellular carcinoma (HCC), defined as tumor size above 10 cm in diameter, places a dramatic disease burden since management options are currently limited, and it usually presents with unfavorable survival [1][2][3][4][5][6]. For instance, most huge HCC patients experience tumor invasion and intrahepatic metastasis, which misses the opportunity of surgical resection as the curative treatment [2,5,6].…”