Outcomes of curative liver resection for hepatocellular carcinoma in patients with cirrhosis

Table 3 Univariate analysis of pre-operative, operative and post-operative factors predictive of hepatic decompensation after liver resection for hepatocellular carcinoma (calculated at 3 mo post-operative)

	No decompensation (70 patients)	Decompensation (50 patients)		P value
Age, n (%)
< 60 yr	36 (58.1)	26 (41.9)	0.004	0.951
≥ 60 yr	34 (58.6)	24 (41.0)
Antiviral therapy for HCV, n (%)
No treatment	34 (46.6)	39 (53.4)	29.143	< 0.001c
DAAs	34 (82.9)	7 (17.1)
Interferon	2 (33.3)	4 (66.7)
Clinically significant portal hypertension, n (%)
No	52 (66.7)	26 (33.3)	7.7	0.006b
Yes	17 (40.5)	25 (59.5)
BCLC stage, n (%)
0	12 (100)	0 (0)	40.0	< 0.001c
A	52 (72.2)	20 (27.8)
B	6 (16.7)	30 (83.3)
MELD score, n (%)
< 10	60 (68.2)	28 (31.8)	22.721	< 0.001c
10-20	4 (15.4)	22 (84.6)
Pre-operative Child-Pugh score, n (%)
A5	54 (60)	36 (40)	0.411	0.521
A6	16 (53.3)	14 (46.7)
AFP (ng/mL), n (%)
< 20	30 (57.7)	22 (42.3)	3.509	0.173
20-400	20 (66.7)	10 (33.3)
> 400	8 (40)	12 (60)
Pre-operative serum bilirubin (mg/dL), n (%)
≤ 1	46 (57.5)	34 (42.5)	0.201	0.654
> 1	18 (52.9)	16 (47.1)
Tumor diameter > 5 cm, n (%)
No	64 (74.4)	22 (25.6)	32.311	< 0.001c
Yes	6 (17.6)	28 (82.4)
Number of tumors, n (%)
Single	68 (60.7)	44 (39.3)	5.869	0.027a
More than one	0 (0)	4 (100)
Site of tumor(s), n (%)
Right lobe	36 (62.1)	22 (37.9)	1.626	0.443
Left lobe	32 (57.1)	24 (42.9)
Bilobar	2 (100)	0 (0)
Milan criteria, n (%)
Within	36 (69.2)	16 (30.8)	15.537	< 0.001c
Beyond	8 (25)	24 (75)
Tumor differentiation, n (%)
Grade 1 or 2	38 (63.3)	22 (36.7)	1.646	0.2
Grade 3 or 4	18 (50)	18 (50)
Lymph/vascular invasion, n (%)
No	38 (70.4)	16 (29.6)	8.593	0.003b
Yes	18 (40.9)	26 (59.1)
Type of resection, n (%)
Open	28 (42.4)	38 (57.6)	13.473	< 0.001c
Laparoscopic	12 (100)	0 (0)
Anatomical resection, n (%)
No	38 (57.6)	28 (42.4)	0.978	0.323
Yes	10 (45.5)	12 (54.5)
Extension of hepatectomy, n (%)
One segment	30 (51.7)	28 (48.3)	2.241	0.326
Two segments	8 (44.4)	10 (55.6)
Three segments	2 (100)	0 (0)
ICU admission, n (%)
No	44 (71)	18 (29)	8.425	0.004b
Yes	26 (44.8)	32 (55.2)
Postoperative complications, n (%)
Hemorrhage	4 (100)	0 (0)	2.956	0.14
Bile leak	0 (0)	2 (100)	2.847	0.172
Wound infection	0 (0)	4 (100)	5.793	0.028a
Chest infection	2 (14.3)	12 (85.7)	12.652	< 0.001c
PHLF, n (%)
Absent	54 (71.1)	22 (28.9)	22.305	< 0.001c
Grade A	10 (62.5)	6 (37.5)
Grade B	6 (27.3)	16 (72.7)
Grade C	0 (0)	6 (100)
50-50 criteria, n (%)
Absent	70 (60.3)	46 (39.7)	5.793	0.028a
Present	0 (0)	4 (100)
HCC recurrence, n (%)	16 (47.1)	18 (52.9)	2.481	0.115
	No decompensation	Decompensation	t-test	P value
	mean ± SD
Post-operative bilirubin (mg/dL)	1.21 ± 0.49	1.98 ± 0.57	-7.353	< 0.001c
Post-operative AFP (ng/mL)	3020.12 ± 13277.79	371.63 ± 761.79	0.931	0.355
Post-operative Child-Pugh score	5.78 ± 0.65	7.62 ± 0.58	-14.768	< 0.001c
Age	58.77 ± 6.68	59.88 ± 6.29	-0.918	0.36
Pre-operative Bilirubin (mg/dL)	0.87 ± 0.31	0.87 ± 0.38	0.007	0.994
Pre-operative MELD score	8.03 ±1.44	9.2 ± 1.96	-3.541	0.001b
Pre-operative Child score	5.23 ± 0.42	5.28 ± 0.45	-0.637	0.525
Pre-operative AFP (ng/mL)	149.58 ± 239.28	251.09 ± 441.64	-1.379	0.173
Tumor diameter (cm)	3.77 ± 1.32	5.68 ± 2.33	-5.238	< 0.001c
ICU stay (d)	2.92 ± 1.35	5.38 ± 5.29	-2.522	0.016a
Hospital stay (d)	6.86 ± 2.08	11.26 ± 6.34	-4.092	< 0.001c
Post-operative bilirubin (mg/dL)	1.21 ± 0.49	1.98 ± 0.57	-7.353	< 0.001c
Post-operative AFP (ng/mL)	3020.12 ± 13277.79	371.63 ± 761.79	0.931	0.355
Post-operative Child-Pugh score	5.78 ± 0.65	7.62 ± 0.58	-14.768	< 0.001c

^aP < 0.05.

^bP < 0.01.

^cP < 0.001.

AFP: Alpha-fetoprotein; BCLC: Barcelona clinic liver cancer; HCC: Hepatocellular carcinoma; MELD: Model for end-stage liver disease; PHLF: Post-hepatectomy liver failure; ICU: Intensive care units; HCV: Hepatitis C virus; DAAs: Direct-acting antiviral agents.