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A comprehensive preoperative predictive score for post-hepatectomy liver failure after hepatocellular carcinoma resection based on patient comorbidities, tumor burden, and liver function: the CTF score

  • Original Article
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Journal of Gastrointestinal Surgery

Abstract

Background

Post-hepatectomy liver failure (PHLF) is a dreaded complication following liver resection for hepatocellular carcinoma (HCC) with a high mortality rate. We sought to develop a score based on preoperative factors to predict PHLF.

Methods

Patients who underwent resection for HCC between 2000 and 2020 were identified from an international multi-institutional database. Factors associated with PHLF were identified and used to develop a preoperative comorbidity-tumor burden-liver function (CTF) predictive score.

Results

Among 1785 patients, 106 (5.9%) experienced PHLF. On multivariate analysis, several factors were associated with PHLF including high Charlson comorbidity index (CCI ≥ 5) (OR 2.80, 95%CI, 1.08–7.26), albumin–bilirubin (ALBI) (OR 1.99, 95%CI, 1.10–3.56), and tumor burden score (TBS) (OR 1.06, 95%CI, 1.02–1.11) (all p < 0.05). Using the beta-coefficients of these variables, a weighted predictive score was developed and made available online (https://alaimolaura.shinyapps.io/PHLFriskCalculator/). The CTF score (c-index = 0.67) performed better than Child–Pugh score (CPS) (c-index = 0.53) or Barcelona clinic liver cancer system (BCLC) (c-index = 0.57) to predict PHLF. A high CTF score was also an independent adverse prognostic factor for survival (HR 1.61, 95%CI, 1.12–2.30) and recurrence (HR 1.36, 95%CI, 1.08–1.71) (both p = 0.01).

Conclusion

Roughly 1 in 20 patients experienced PHLF following resection of HCC. Patient (i.e., CCI), tumor (i.e., TBS), and liver function (i.e., ALBI) factors were associated with risk of PHLF. These preoperative factors were incorporated into a novel CTF tool that was made available online, which outperformed other previously proposed tools.

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Authors and Affiliations

  1. Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA

    Laura Alaimo, Yutaka Endo, Henrique A. Lima, Zorays Moazzam, Chanza Fahim Shaikh & Timothy M. Pawlik

  2. Department of Surgery, University of Verona, Verona, Italy

    Laura Alaimo, Andrea Ruzzenente & Alfredo Guglielmi

  3. Department of Surgery, Ospedale San Raffaele, Milan, Italy

    Francesca Ratti & Luca Aldrighetti

  4. Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal

    Hugo P. Marques

  5. Department of Hepatibiliopancreatic Surgery, APHP, Beaujon Hospital, Clichy, France

    François Cauchy

  6. Department of Surgery, Westmead Hospital, Sydney, NSW, Australia

    Vincent Lam

  7. Department of Surgery, Stanford University, Stanford, CA, USA

    George A. Poultsides

  8. Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania

    Irinel Popescu & Sorin Alexandrescu

  9. Department of Surgery, University of Ottawa, Ottawa, ON, Canada

    Guillaume Martel

  10. Department of Surgery, School of Medicine, The University of Sydney, Sydney, NSW, Australia

    Tom Hugh

  11. Yokohama City University School of Medicine, Yokohama, Japan

    Itaru Endo

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  1. Laura Alaimo
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  12. Vincent Lam
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Correspondence to Timothy M. Pawlik.

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Alaimo, L., Endo, Y., Lima, H.A. et al. A comprehensive preoperative predictive score for post-hepatectomy liver failure after hepatocellular carcinoma resection based on patient comorbidities, tumor burden, and liver function: the CTF score. J Gastrointest Surg 26, 2486–2495 (2022). https://doi.org/10.1007/s11605-022-05451-5

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