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Predicting Post-hepatectomy Liver Failure Preoperatively for Child-Pugh A5 Hepatocellular Carcinoma Patients by Liver Stiffness

  • Original Article
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Journal of Gastrointestinal Surgery

Abstract

Background

Post-hepatectomy liver failure (PHLF) represents the major source of mortality after liver resection (LR) in hepatocellular carcinoma (HCC) patients. Child-Pugh (CP) score 5 is always considered to indicate a normal liver function but represents a heterogeneous population with a considerable number suffering from PHLF. The present study aimed to access the ability of liver stiffness (LS) measured by two-dimensional shear wave elastography (2D-SWE) to predict PHLF in HCC patients with a CP score of 5.

Methods

From August 2018 to May 2021, 146 HCC patients with a CP score of 5 who underwent LR were reviewed. The patients were randomly divided into training (n = 97) and validation (n = 49) groups. Logistic analyses were conducted for the risk factors and a linear model was built to predict the development of PHLF. The discrimination and calibration were assessed in the training and validation cohorts by the areas under the receiver operating characteristic curve (AUC).

Results

Analyses revealed that the minimum of LS (Emin) higher than 8.05 (p = 0.006, OR = 4.59) and future liver remnant / estimated total liver volume (FLR/eTLV) (p < 0.001, OR < 0.01) were independent predictors of PHLF in HCC patients with CP score 5, and the AUC calculated by the model based on them for differentiation of PHLF in the training and validation group was 0.78 and 0.76, respectively.

Conclusion

LS was associated with the development of PHLF. A model combining Emin and FLR/eTLV showed proper ability in predicting PHLF in HCC patients with a CP score of 5.

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Data Availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Funding

This study was supported by the Natural Science Foundation of Guangdong Province (Grant No. 2021A1515012367), the Youth Program of the National Natural Science Foundation of China (Grant No. 81901768), and the Major Program of the National Natural Science Foundation of China (Grant No. 92059201).

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Authors and Affiliations

  1. Department of Medical Ultrasonics, Sun Yat-Sen University First Affiliated Hospital, No. 58, Zhongshan Road II, Yuexiu District, Guangzhou, 510080, Guangdong, China

    Jiayao Huang, Haiyi Long, Jianyun Peng, Xian Zhong, Yifan Shi, Xiaoyan Xie & Manxia Lin

  2. Department of Liver Surgery, Sun Yat-Sen University First Affiliated Hospital, Guangdong, China

    Ming Kuang

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Contributions

Jiayao Huang: Management of the data; application of statistical techniques to analyze and synthesize the data; preparation of the published work (including writing the draft); revision of the work; final approval of the manuscript submitted.

Haiyi Long, Jianyun Peng, Xian Zhong and Yifan Shi: Acquisition and management of the data; revision of the work; final approval of the manuscript submitted.

Xiaoyan Xie and Ming Kuang: Supervision for the research; management and coordination for the research; funding acquisition; revision of the work; final approval of the manuscript submitted.

Manxia Lin: Supervision and verification for the research; preparation of the published work (including critical review, commentary, and revision); management and coordination for the research; funding acquisition; revision of the work; final approval of the manuscript submitted.

Corresponding author

Correspondence to Manxia Lin.

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The protocol of this single-centre retrospective study was approved by the Institutional Review Board of the First Affiliated Hospital of Sun Yat-sen University, and it waived the need to obtain written informed consent for data analysis.

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Supplementary Information

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11605_2023_5635_MOESM1_ESM.bmp

Supplemental Figure 1. Emean's ROC Curve in the training group. Note: Emean, mean of liver stiffness; ROC, receiver operating characteristic. (BMP 3309 KB)

11605_2023_5635_MOESM2_ESM.bmp

Supplemental Figure 2. Emin's ROC Curve in the training group. Note: Emin, minimum of liver stiffness; ROC, receiver operating characteristic. (BMP 3309 KB)

11605_2023_5635_MOESM3_ESM.bmp

Supplemental Figure 3. Emax's ROC Curve in the training group. Note: Emax, maximum of liver stiffness; ROC, receiver operating characteristic. (BMP 3309 KB)

Supplemental Table 1 (DOCX 16 KB)

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Huang, J., Long, H., Peng, J. et al. Predicting Post-hepatectomy Liver Failure Preoperatively for Child-Pugh A5 Hepatocellular Carcinoma Patients by Liver Stiffness. J Gastrointest Surg 27, 1177–1187 (2023). https://doi.org/10.1007/s11605-023-05635-7

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