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Combining Aspartate Aminotransferase-to-Platelet Ratio Index with Future Liver Remnant to Assess Preoperative Hepatic Functional Reserve in Patients with Hepatocellular Carcinoma

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Accurate preoperative assessment of hepatic functional reserve is essential for conducting a safe hepatectomy. In recent years, aspartate aminotransferase-to-platelet ratio index (APRI) has been used as a noninvasive model for assessing fibrosis stage, hepatic functional reserve, and prognosis after hepatectomy with a high level of accuracy. The purpose of this research was to evaluate the clinical value of combining APRI with standardized future liver remnant (sFLR) for predicting severe post-hepatectomy liver failure (PHLF) in patients with hepatocellular carcinoma (HCC).

Methods

Six hundred thirty-seven HCC patients who had undergone hepatectomy were enrolled in this study. The performance of the Child-Pugh (CP) grade, model for end-stage liver disease (MELD), APRI, sFLR, and APRI-sFLR in predicting severe PHLF was assessed using the area under the ROC curve (AUC).

Results

Severe PHLF was found to have developed in 101 (15.9%) patients. Multivariate logistic analyses identified that prealbumin, cirrhosis, APRI score, sFLR, and major resection were significantly associated with severe PHLF. The AUC values of the CP, MELD, APRI, and sFLR were 0.626, 0.604, 0.725, and 0.787, respectively, indicating that the APRI and sFLR showed significantly greater discriminatory abilities than CP and MELD (P < 0.05 for all). After APRI was combined with sFLR, the AUC value of APRI-sFLR for severe PHLF was 0.816, which greatly improved the prediction accuracy, compared with APRI or sFLR alone (P < 0.05 for all). Stratified analysis using the status of cirrhosis and extent of resection yielded similar results. Moreover, the incidence and grade of PHLF were significantly different among the three risk groups.

Conclusion

The combination of APRI and sFLR can be considered to be a predictive factor with increased accuracy for severe PHLF in HCC patients, compared with CP grade, MELD, APRI, or sFLR alone.

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Abbreviations

HCC:

hepatocellular carcinoma

PHLF:

post-hepatectomy liver failure

CP:

Child-Pugh

MELD:

model for end-stage liver disease

APRI:

aspartate aminotransferase-to-platelet ratio index

FLR:

future liver remnant

eTLV:

estimated total liver volume

sFLR:

standardized future liver remnant

CSPH:

clinically significant portal hypertension

ROC:

receiver operating characteristic

AUC:

area under the ROC curve

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Funding

The study was supported by the National Science Foundation of China Youth Fund Project (81803007), National Natural Science Foundation of China (81460426), 66th Chinese Post-Doctoral Science Foundation Project (2019M663412), Project of GuangXi Natural Science Foundation (2019JJA140151), Regional Science Fund Project of China Natural Science Foundation (81660498), Youth Talent Fund Project of Guangxi Natural Science Foundation (Nos. 2016GXNSFBA380090, 2018GXNSFBA281030, and 2018GXNSFBA281091), and Guangxi Medical and Health Appropriate Technology Development and Application Project (Nos. S2017101 and S2018062).

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Author notes

  1. Rong-yun Mai, Jie Zeng and Hua-ze Lu contributed equally to this work.

Authors and Affiliations

  1. Department of Hepatobilliary & Pancreatic Surgery, Guangxi Medical University Cancer Hospital, 71 He Di Road, Nanning, 530021, China

    Rong-yun Mai, Hua-ze Lu, Guo-bin Wu, Fei-xiang Wu, Liang Ma, Bang-de Xiang, Le-qun Li & Jia-zhou Ye

  2. Department of Experimental Research, Guangxi Medical University Cancer Hospital, Nanning, 530021, China

    Rong-yun Mai, Jie Zeng, Xue-min Piao & Xing Gao

  3. Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Center, Nanning, 530021, China

    Rong-yun Mai, Jie Zeng, Hua-ze Lu, Rong Liang, Yan Lin, Xue-min Piao, Xing Gao, Guo-bin Wu, Fei-xiang Wu, Liang Ma, Bang-de Xiang, Le-qun Li & Jia-zhou Ye

  4. Department of First Chemotherapy, Guangxi Medical University Cancer Hospital, Nanning, 530021, China

    Rong Liang, Yan Lin, Xue-min Piao & Xing Gao

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  1. Rong-yun Mai
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Contributions

Conception: Rong-yun Mai, Jie Zeng, Le-qun Li, and Jia-zhou Ye; study design: Rong-yun Mai, Guo-bin Wu, Fei-xiang Wu, Liang Ma, Bang-de Xiang, and Jia-zhou Ye; administrative support: Le-qun Li; data collection and acquisition: Rong-yun Mai, Jie Zeng, Hua-ze Lu, Xue-min Piao, Xing Gao; data analysis: Rong-yun Mai, Jie Zeng, Hua-ze Lu, Hua-ze Lu, Rong Liang, and Yan Lin; manuscript preparation: Rong-yun Mai, Jie Zeng, and Hua-ze Lu; critical revision: Rong-yun Mai and Jia-zhou Ye; final approval of manuscript: all authors.

Corresponding authors

Correspondence to Le-qun Li or Jia-zhou Ye.

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Supplementary Figure 1

Three-dimensional reconstruction and virtual hepatectomy. Red, hepatic artery; dark blue, hepatic vein; lake blue, portal vein; khaki, tumor; brown, hepatic parenchyma; dark green, gall bladder. (A) Computed tomography scan of the left HCC. (B) Volume of the re-constructional liver. (C) Virtual hepatectomy prior to surgery. (D) Remnant liver volume after virtual hepatectomy. Abbreviation: HCC, hepatocellular carcinoma. (PNG 3740 kb)

High resolution image (TIF 27338 kb)

Supplementary Figure 2

Relationship of incidence and PHLF grade based on risk group stratification assessed using the APRI-sFLR score in the subgroups of HCC patients. Abbreviation: APRI-sFLR, combination of APRI and sFLR; PHLF, posthepatectomy liver failure; HCC, hepatocellular carcinoma. (PNG 507 kb)

High resolution image (TIF 20736 kb)

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Mai, Ry., Zeng, J., Lu, Hz. et al. Combining Aspartate Aminotransferase-to-Platelet Ratio Index with Future Liver Remnant to Assess Preoperative Hepatic Functional Reserve in Patients with Hepatocellular Carcinoma. J Gastrointest Surg 25, 688–697 (2021). https://doi.org/10.1007/s11605-020-04575-w

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