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Liver Stiffness Assessed by Shear Wave Elastography Predicts Postoperative Liver Failure in Patients with Hepatocellular Carcinoma

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Cirrhosis increases a patient’s risk of developing postoperative liver failure (PLF). Liver stiffness (LS), assessed by two-dimensional shear wave elastography (SWE), indicates liver fibrosis with high accuracy. Whether LS is superior to portal hypertension (PHT) in predicting PLF remains to be studied.

Methods

The study enrolled 280 patients who underwent hepatectomy for hepatocellular carcinoma from July 2015 to July 2016. All patients received preoperative assessments for LS, PHT, and serum markers of liver fibrosis in addition to other clinicopathological tests. Risk factors for grade A and grade B (or greater) PLF were subjected to univariate and multivariate analysis and receiver operating characteristic curve analysis.

Results

Fifty-five patients (19.6%) experienced PLF. The cutoff value of LS for predicting cirrhosis was 10.1 kPa. Multivariate analysis identified LS, hyaluronic acid, IV collagen, and the presence of splenomegaly as independent predictors of PLF. The cutoff value of LS for predicting PLF and grade B (or greater) PLF was 11.75 and 11.9 kPa, respectively. LS was superior to PHT in predicting PLF or greater than grade B PLF (0.72 vs. 0.60, 0.76 vs. 0.59, P < 0.05).

Conclusion

LS measured by SWE can predict risk of PLF with greater accuracy than PHT.

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Acknowledgements

The authors thank Xianjing Zhang M.A., a statistician at the Statistical Analysis Division of Shanghai Medical Insurance Administration Center, for advice on statistical analysis.

This work was supported by grants from the Leading Investigator Program of Shanghai municipal government (2016), the National Key Basic Research Program (973 project) (2015CB554005) from the Ministry of Science and Technology of China, the National Natural Science Foundation of China (81472672), and the Natural Science Foundation of Shanghai (17ZR1405400).

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Author notes

  1. Yinghao Shen, Chenhao Zhou, and Guodong Zhu contributed equally to this work.

Authors and Affiliations

  1. Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, 200032, China

    Yinghao Shen, Chenhao Zhou, Guoming Shi, Xiaodong Zhu, Cheng Huang, Jian Zhou, Jia Fan, Ning Ren & Hui-Chuan Sun

  2. Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, China

    Yinghao Shen, Chenhao Zhou, Guoming Shi, Xiaodong Zhu, Cheng Huang, Jian Zhou, Jia Fan, Ning Ren & Hui-Chuan Sun

  3. The Third Affiliated Hospital, Nantong University, Nantong, Jiangsu Province, China

    Guodong Zhu

  4. Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China

    Hong Ding

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  1. Yinghao Shen
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Contributions

S.Y.H., Z.C.H., and Z.G.D. performed analyses of the data and wrote the manuscript. S.G.M., Z.X.D., and H.C. collected the data. Z.J., F.J., and D.H. edited the manuscript. R.N. and S.H.C. conceived the study and wrote the manuscript. All authors reviewed the manuscript.

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Correspondence to Ning Ren or Hui-Chuan Sun.

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Shen, Y., Zhou, C., Zhu, G. et al. Liver Stiffness Assessed by Shear Wave Elastography Predicts Postoperative Liver Failure in Patients with Hepatocellular Carcinoma. J Gastrointest Surg 21, 1471–1479 (2017). https://doi.org/10.1007/s11605-017-3443-9

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  • DOI: https://doi.org/10.1007/s11605-017-3443-9

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