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Predicting symptomatic post-hepatectomy liver failure in patients with hepatocellular carcinoma: development and validation of a preoperative nomogram

  • Hepatobiliary-Pancreas
  • Published:
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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).

Author information

Author notes

  1. Xiaoyan Xie and Manxia Lin shared the authorship for the last authors, for their equal contribution to this article, including conceptualization, funding acquisition, investigation, project administration, supervision, and writing (review and editing).

Authors and Affiliations

  1. Division of Interventional Ultrasound, Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, No.58 Zhong Shan Road 2, Guangzhou, 510080, China

    Haiyi Long, Xian Zhong, Yifan Shi, Yu Duan, Xiaohua Xie, Ming Kuang, Xiaoyan Xie & Manxia Lin

  2. Department of Ultrasonography, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China

    Chuan Peng & Jianhua Zhou

  3. Department of Ultrasound, Huashan Hospital, Fudan University. No. 12 Middle Urumqi Road, Shanghai, 200040, China

    Hong Ding

  4. Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China

    Yun Zheng

  5. State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China

    Yun Zheng

  6. Department of Pancreaticobiliary Surgery, The First Affiliated Hospital of Sun Yat-Sen University, No.58 Zhong Shan Road 2, Guangzhou, 510080, China

    Wei Chen

  7. Department of Liver Surgery, The First Affiliated Hospital of Sun Yat-Sen University, No.58 Zhong Shan Road 2, Guangzhou, 510080, China

    Ming Kuang

Authors
  1. Haiyi Long
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  2. Chuan Peng
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  3. Hong Ding
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Corresponding authors

Correspondence to Xiaoyan Xie or Manxia Lin.

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Guarantor

The scientific guarantor of this publication is Prof. Xiaoyan Xie.

Conflicts of interest

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.

Statistics and biometry

Prof. Chen Yuming, an expert in statistics from the School of Public Health, Sun Yat-sen University, has provided statistical advice in this manuscript.

Informed consent

Written informed consent was obtained from all patients in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

  • prospective

  • diagnostic or prognostic study

  • 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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