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Nomogram based on CT–derived extracellular volume for the prediction of post-hepatectomy liver failure in patients with resectable hepatocellular carcinoma

  • Computed Tomography
  • Published:
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An Editorial Comment to this article was published on 08 September 2022

Abstract

Objectives

This study aimed to develop and validate a nomogram based on extracellular volume (ECV) derived from computed tomography (CT) for predicting post-hepatectomy liver failure (PHLF) in patients with resectable hepatocellular carcinoma (HCC).

Methods

A total of 202 patients with resectable HCC from two hospitals were enrolled and underwent multiphasic contrast-enhanced CT before surgery. One hundred twenty-one patients from our hospital and 81 patients from another hospital were assigned to the training cohort and the validation cohort, respectively. CT–derived ECV was measured using nonenhanced and equilibrium-phase-enhanced CT images. The nomogram was developed with independent predictors of PHLF. Predictive performance and calibration were assessed by receiver operator characteristic (ROC) analysis and Hosmer–Lemeshow test, respectively. The Delong test was used to compare the areas under the curve (AUCs).

Results

CT–derived ECV had a strong correlation with the postoperative pathological fibrosis stage of the background liver (p < 0.001, r = 0.591). The nomogram combining CT–derived ECV, serum albumin (Alb), and serum total bilirubin (Tbil) obtained higher AUCs than the albumin–bilirubin (ALBI) score for predicting PHLF in both the training cohort (0.828 vs. 0.708; p = 0.004) and the validation cohort (0.821 vs. 0.630; p < 0.001). The nomogram showed satisfactory goodness of fit for PHLF prediction in the training and validation cohorts (p = 0.621 and 0.697, respectively).

Conclusions

The nomogram contributes to the preoperative prediction of PHLF in patients with resectable HCC.

Key Points

• CT–derived ECV had a strong correlation with the postoperative pathological fibrosis stage of the background liver.

• CT–derived ECV was an independent predictor of PHLF in patients with resectable HCC.

• The nomogram based on CT–derived ECV showed a superior prediction efficacy than that of clinical models (including Child–Pugh stage, MELD score, and ALBI score).

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Abbreviations

Alb:

Albumin

ALBI:

Albumin–bilirubin

AUC:

Area under the curve

CT:

Computed tomography

ECV:

Extracellular volume

EP:

Equilibrium phase

HCC:

Hepatocellular carcinoma

Hct:

Hematocrit

ISGLS:

International Study Group of Liver Surgery

MELD:

Model for End-Stage Liver Disease

PHLF:

Post-hepatectomy liver failure

ROC:

Receiver operator characteristic

ROI:

Region of interest

Tbil:

Total bilirubin

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Acknowledgements

We would like thank all the participants of this study.

Funding

This study has received funding from the National Natural Science Foundation of China (Grant No. 82071883), the combination projects of medicine and engineering of the Fundamental Research Funds for the Central Universities in 2019 (Project No. 2019CDYGYB008), and the Chongqing key medical research project of a combination of science and medicine (Grant No. 2021MSXM077).

Author information

Author notes

  1. Yangling Peng and Hesong Shen contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, 400030, People’s Republic of China

    Yangling Peng, Hesong Shen, Hao Tang, Xiaosong Lan & Jiuquan Zhang

  2. Department of Hematology, Chongqing General Hospital, University of the Chinese Academy of Sciences, Chongqing, People’s Republic of China

    Yuanying Huang

  3. Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), Chongqing University Cancer Hospital, Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, People’s Republic of China

    Xianzhang Luo

  4. Siemens Healthineers, Xi’an, People’s Republic of China

    Xiaoyue Zhang

Authors
  1. Yangling Peng
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  2. Hesong Shen
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Corresponding author

Correspondence to Jiuquan Zhang.

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Guarantor

The scientific guarantor of this publication is Jiuquan Zhang, from the Department of Radiology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, People’s Republic of China, email: zhangjq_radiol@foxmail.com.

Conflict of interest

One of the authors (Xiaoyue Zhang) of this manuscript is an employee of Siemens Healthineers. The remaining authors declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approvals of the two participating hospitals were obtained.

Methodology

retrospective

diagnostic or prognostic study

multicenter study

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Supplementary Information

Figure S1.

Handcrafted ROIs diagram and calculation process of the CT-derived ECV. A 39-year-old man with HCC, underwent a major hepatectomy (resection of right lobe and caudate lobe of liver) and with a known of Hct value was 47%. In the preoperative baseline nonenhanced (A-C) and EP enhanced (D-F) images, handcrafted ROIs were drawn along the margins of the future remnant liver, and circular ROIs were drawn in the abdominal aorta on the same plane. ROIs were placed on three cross-sections, including intrahepatic inferior vena cava confluence (A, D), portal hilum (B, E) and gallbladder fossa (C, F). The ECV values of the section at intrahepatic inferior vena cava confluence (ECV1), portal hilum (ECV2) and gallbladder fossa (ECV3) were calculated by the formula shown in the figure, respectively. Then the CT-derived ECV for the patient (ECV = 33.00) was the mean value of ECV1, ECV2 and ECV3. ROI, region of interest; CT, computed tomography; ECV, extracellular volume; HCC, hepatocellular carcinoma; EP, equilibrium phase; Hct, hematocrit. (PNG 9760 kb)

High resolution image (TIF 5843 kb)

Figure S2.

Bland–Altman plots of the CT-derived ECV differences measured by radiologist 1 with an interval of 4 weeks (A, C), and radiologist 1/2 (B, D). A/B and C/D were for the training and validation cohort, respectively. These Bland–Altman plots showed good agreement. CT, computed tomography; ECV, extracellular volume. (PNG 265 kb)

High resolution image (TIF 698 kb)

Figure S3.

Two examples of clinical application of our nomogram. (A) a 51-year-old man with resectable HCC, the point of CT-derived ECV (22.00), serum Alb (38.00 g/L) and serum Tbil (18.98 μmol/L) were indicated by orange dotted lines, then the total point of this patient was indicated by red dotted line, indicating that the risk of PHLF in this patient was much less than 35%. (B) a 64-year-old man with resectable HCC, the point of CT-derived ECV (27.01), serum Alb (33.61 g/L) and serum Tbil (131.13 μmol/L) were indicated by orange dotted lines, then the total point of this patient was indicated by red dotted line, indicating that the risk of PHLF in this patient was exceeded 85%. Therefore, this patient should consider a new strategy for clinical treatment. HCC, hepatocellular carcinoma; CT, computed tomography; ECV, extracellular volume; Alb, albumin; Tbil, total bilirubin; PHLF, post-hepatectomy liver failure. (PNG 543 kb)

High resolution image (TIF 665 kb)

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Peng, Y., Shen, H., Tang, H. et al. Nomogram based on CT–derived extracellular volume for the prediction of post-hepatectomy liver failure in patients with resectable hepatocellular carcinoma. Eur Radiol 32, 8529–8539 (2022). https://doi.org/10.1007/s00330-022-08917-x

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