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Predictors of Futile Liver Resection for Patients with Barcelona Clinic Liver Cancer Stage B/C Hepatocellular Carcinoma

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

There is little information concerning futile liver resection for patients with Barcelona Clinic Liver Cancer (BCLC) stage B/C hepatocellular carcinoma (HCC). This study aimed to establish a predictive model of futile liver resection for patients with BCLC stage B/C HCC.

Methods

The outcomes of 484 patients with BCLC stage B/C HCC who underwent liver resection at our centre between 2010 and 2016 were reviewed. Patients were randomised and divided 2:1 into training and validation sets. A novel risk-scoring model and prognostic nomogram were developed based on the results of multivariate analysis.

Results

Fifty-seven futile operations were observed. Multivariate analyses revealed tumour numbers > 3, Vp4 portal vein tumour thrombosis (PVTT) and alpha-fetoprotein (AFP) > 400 ng/ml independently associated with futile liver resection. A risk-scoring model based on the above-mentioned factors was developed (predictive risk score = 1 × (if AFP > 400 ng/ml) + 2 × (if tumour number > 3) + 3 × (if with Vp4 PVTT)). The area under the receiver-operating characteristic curve of this model was 0.845, with a sensitivity of 60.0% and a specificity of 94.8%. A prognostic nomogram was also developed and achieved a C-index of 0.831. The validation studies optically supported these results.

Conclusion

A risk-scoring model and predictive nomogram for futile liver resection were developed in the present study. T`he BCLC stage B/C HCC patients with a high risk obtained no benefit from liver resection.

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Abbreviations

BCLC:

Barcelona Clinic Liver Cancer

HCC:

Hepatocellular carcinoma

PVTT:

Portal vein tumour thrombosis

AFP:

Alpha-fetoprotein

TACE:

Transarterial chemoembolization

HBV-DNA:

Hepatitis B virus-DNA

MVI:

Microvascular invasion

ALBI:

Albumin-bilirubin

ROC:

Receiver-operating characteristic

RFS:

Recurrence-free survival

OS:

Overall survival

TNM:

Tumour node metastasis

AUC:

Area under receiver-operating characteristic

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Acknowledgements

The authors thank the language editing service from American Journal Experts.

Funding

This study was supported by grants from the Science and Technological Supports Project of Sichuan Province (2016SZ0025 and 2015SZ0049) as well as the Health and Family Planning Commission of Sichuan Province (17PJ393).

Author information

Authors and Affiliations

  1. Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China

    Chuan Li, Jun-Yi Shen, Xiao-Yun Zhang, Wei Peng, Tian-Fu Wen, Jia-Yin Yang & Lu-Nan Yan

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  1. Chuan Li
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  2. Jun-Yi Shen
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  3. Xiao-Yun Zhang
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  4. Wei Peng
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  5. Tian-Fu Wen
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Contributions

Li C, Yang JY, Yan LN and Wen TF proposed this study. Li C, Shen JY, Zhang XY and Peng W collected the data. Li C and Shen JY analysed the data.

Corresponding author

Correspondence to Tian-Fu Wen.

Ethics declarations

This study was approved by the ethics committee of West China Hospital (NO: 201762).

Conflict Interest

The authors declare that they have no conflict of interest.

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Li, C., Shen, JY., Zhang, XY. et al. Predictors of Futile Liver Resection for Patients with Barcelona Clinic Liver Cancer Stage B/C Hepatocellular Carcinoma. J Gastrointest Surg 22, 496–502 (2018). https://doi.org/10.1007/s11605-017-3632-6

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  • DOI: https://doi.org/10.1007/s11605-017-3632-6

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