Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 21, 2015; 21(31): 9394-9402
Published online Aug 21, 2015. doi: 10.3748/wjg.v21.i31.9394
Safety validation of decision trees for hepatocellular carcinoma
Xian-Qiang Wang, Zhe Liu, Wen-Ping Lv, Ying Luo, Guang-Yun Yang, Chong-Hui Li, Xiang-Fei Meng, Yang Liu, Ke-Sen Xu, Jia-Hong Dong
Xian-Qiang Wang, Ke-Sen Xu, Jia-Hong Dong, Department of Hepatobiliary Surgery, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China
Zhe Liu, Wen-Ping Lv, Ying Luo, Guang-Yun Yang, Chong-Hui Li, Xiang-Fei Meng, Yang Liu, Jia-Hong Dong, Department of Hepatobiliary Surgery, PLA General Hospital, Beijing 100853, China
Author contributions: Dong JH, Lv WP and Xu KS designed the research; Wang XQ and Liu Z performed the research; Li CH and Yang GY contributed new reagents and analytic tools; Liu Y and Meng XF analyzed the data; and Wang XQ and Luo Y wrote the paper.
Supported by Grants from the Project of the National Science and Technology Major Project, No. 2012BAI06B01; and Postdoctoral Science Foundation funded project, No. 201003781.
Institutional review board statement: The study was reviewed and approved by the PLA General Hospital Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflicting interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jia-Hong Dong, MD, PhD, FACS, Department of Hepatobiliary Surgery, PLA General Hospital, No. 28 Fuxing Road, Beijing 100853, China. dongjh_301@163.com
Telephone: +86-10-66938030 Fax: +86-10-66938030
Received: November 2, 2014
Peer-review started: November 2, 2014
First decision: December 2, 2014
Revised: March 11, 2015
Accepted: April 17, 2015
Article in press: April 17, 2015
Published online: August 21, 2015
Processing time: 290 Days and 16.6 Hours
Abstract

AIM: To evaluate a different decision tree for safe liver resection and verify its efficiency.

METHODS: A total of 2457 patients underwent hepatic resection between January 2004 and December 2010 at the Chinese PLA General Hospital, and 634 hepatocellular carcinoma (HCC) patients were eligible for the final analyses. Post-hepatectomy liver failure (PHLF) was identified by the association of prothrombin time < 50% and serum bilirubin > 50 μmol/L (the “50-50” criteria), which were assessed at day 5 postoperatively or later. The Swiss-Clavien decision tree, Tokyo University-Makuuchi decision tree, and Chinese consensus decision tree were adopted to divide patients into two groups based on those decision trees in sequence, and the PHLF rates were recorded.

RESULTS: The overall mortality and PHLF rate were 0.16% and 3.0%. A total of 19 patients experienced PHLF. The numbers of patients to whom the Swiss-Clavien, Tokyo University-Makuuchi, and Chinese consensus decision trees were applied were 581, 573, and 622, and the PHLF rates were 2.75%, 2.62%, and 2.73%, respectively. Significantly more cases satisfied the Chinese consensus decision tree than the Swiss-Clavien decision tree and Tokyo University-Makuuchi decision tree (P < 0.01，P < 0.01); nevertheless, the latter two shared no difference (P = 0.147). The PHLF rate exhibited no significant difference with respect to the three decision trees.

CONCLUSION: The Chinese consensus decision tree expands the indications for hepatic resection for HCC patients and does not increase the PHLF rate compared to the Swiss-Clavien and Tokyo University-Makuuchi decision trees. It would be a safe and effective algorithm for hepatectomy in patients with hepatocellular carcinoma.

Keywords: Hepatectomy; Liver failure; Decision tree

Core tip: We have established a decision tree for safe hepatectomy based on four variables: normal or cirrhotic liver, Child-Turcotte-Pugh score, the indocyanine green retention rate at 15 min, and the ratio of reserved functional liver volume to standard liver volume. Post-hepatectomy liver failure (PHLF) has been identified by the “50-50” criteria. The Chinese consensus decision tree expands the indications for hepatic resection for liver tumor and does not increase the PHLF rate compared to the Swiss-Clavien and Tokyo University-Makuuchi decision trees. The Chinese consensus decision tree would be a safe and effective algorithm for hepatectomy in patients with liver tumor.