Abstract
Objective
To develop and validate a nomogram based on liver stiffness (LS) for predicting symptomatic post-hepatectomy (PHLF) in patients with hepatocellular carcinoma (HCC).
Methods
A total of 266 patients with HCC were enrolled prospectively from three tertiary referral hospitals from August 2018 to April 2021. All patients underwent preoperative laboratory examination to obtain parameters of liver function. Two-dimensional shear wave elastography (2D-SWE) was performed to measure LS. Three-dimensional virtual resection obtained the different volumes including future liver remnant (FLR). A nomogram was developed by using logistic regression and determined by receiver operating characteristic (ROC) curve analysis and calibration curve analysis, which was validated internally and externally.
Results
A nomogram was constructed with the following variables: FLR ratio (FLR of total liver volume), LS greater than 9.5 kPa, Child–Pugh grade, and the presence of clinically significant portal hypertension (CSPH). This nomogram enabled differentiation of symptomatic PHLF in the derivation cohort (area under curve [AUC], 0.915), internal fivefold cross-validation (mean AUC, 0.918), internal validation cohort (AUC, 0.876) and external validation cohort (AUC, 0.845). The nomogram also showed good calibration in the derivation, internal validation, and external validation cohorts (Hosmer–Lemeshow goodness-of-fit test, p = 0.641, p = 0.06, and p = 0.127, respectively). Accordingly, the safe limit of the FLR ratio was stratified using the nomogram.
Conclusion
An elevated level of LS was associated with the occurrence of symptomatic PHLF in HCC. A preoperative nomogram integrating LS, clinical and volumetric features was useful in predicting postoperative outcomes in patients with HCC, which might help surgeons in the management of HCC resection.
Clinical relevance statement
A serial of the safe limit of the future liver remnant was proposed by a preoperative nomogram for hepatocellular carcinoma, which might help surgeons in ‘how much remnant is enough in liver resection’.
Key Points
• An elevated liver stiffness with the best cutoff value of 9.5 kPa was associated with the occurrence of symptomatic post-hepatectomy liver failure in hepatocellular carcinoma.
• A nomogram based on both quality (Child–Pugh grade, liver stiffness, and portal hypertension) and quantity of future liver remnant was developed to predict symptomatic post-hepatectomy liver failure for HCC, which enabled good discrimination and calibration in both derivation and validation cohorts.
• The safe limit of future liver remnant volume was stratified using the proposed nomogram, which might help surgeons in the management of HCC resection.
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Abbreviations
- CSPH:
-
Clinically significant portal hypertension
- FLR:
-
Future liver remnant
- HCC:
-
Hepatocellular carcinoma
- LS:
-
Liver stiffness
- PHLF:
-
Post-hepatectomy liver failure
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Funding
This research was supported by the Natural Science Foundation of Guangdong Province (Grant No. 2021A1515012367, No. 2023A1515012464), and the Major Program of the National Natural Science Foundation of China (Grant No. 92059201).
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The scientific guarantor of this publication is Prof. Xiaoyan Xie.
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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. All authors declare they have no conflict of interest to disclose.
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Prof. Chen Yuming, an expert in statistics from the School of Public Health, Sun Yat-sen University, has provided statistical advice in this manuscript.
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Written informed consent was obtained from all patients in this study.
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prospective
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diagnostic or prognostic study
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performed at three institutions
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Long, H., Peng, C., Ding, H. et al. Predicting symptomatic post-hepatectomy liver failure in patients with hepatocellular carcinoma: development and validation of a preoperative nomogram. Eur Radiol 33, 7665–7674 (2023). https://doi.org/10.1007/s00330-023-09803-w
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DOI: https://doi.org/10.1007/s00330-023-09803-w