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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Nomogram based on liver stiffness and spleen area with ultrasound for posthepatectomy liver failure: A multicenter study
Guang-Wen Cheng, Yan Fang, Li-Yun Xue, Yan Zhang, Xiao-Yan Xie, Xiao-Hui Qiao, Xue-Qi Li, Jia Guo, Hong Ding
Guang-Wen Cheng, Yan Fang, Li-Yun Xue, Xiao-Hui Qiao, Xue-Qi Li, Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai 200040, China
Yan Zhang, Jia Guo, Department of Ultrasound, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
Xiao-Yan Xie, Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, Sun Yat-sen University First Affiliated Hospital, Guangzhou 510080, Guangdong Province, China
Xue-Qi Li, Institute of Ultrasound in Medicine and Engineering, Shanghai Cancer Center, Shanghai 200040, China
Jia Guo, Department of Ultrasound, Eastern Hepatobiliary Surgical Hospital, Second Military Medical University, Shanghai 200433, China
Hong Ding, Department of Ultrasound, National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
Co-first authors: Guang-Wen Cheng and Yan Fang.
Co-corresponding authors: Jia Guo and Hong Ding.
Author contributions: Cheng GW and Fang Y were responsible for designing the study, collecting data, analyzing data, and writing the paper. They contributed equally to this study. Xue LY, Zhang Y, Xie XY, Qiao XH, and Li XQ were responsible for the collection of cases and the collation of data. Ding H, Guo J and Xie XY were responsible for the authenticity and completeness of data from the center A and C, center B and D, and center E, respectively. All authors approved the final version of the manuscript for submission for publication. Ding H and Guo J contributed equally to this work as co-corresponding authors in responsibility for the design of the study, ethics, and overall research process, as well as for the writing and revision of the article.
Supported by the National Natural Science Foundations of China, No. 81873897 and No. 82102050; Shanghai Science and Technology Development Foundation, No. 22Y11911500; and Shanghai Municipal Health Commission of Science and Research Fund, No. 202140378.
Institutional review board statement: The study was reviewed and approved by the Medical Ethics Committee of Huashan Hospital of Fudan University (Approval No. 2020-1204).
Informed consent statement: All patients signed a presurgical informed consent form.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: The data underlying this article are available in HIMedc data manage system based on REDCap, at http: //www.himedc.cn and requires authors’ consent to be shared.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Hong Ding, MD, PhD, Professor, Department of Ultrasound, Huashan Hospital, Fudan University, No. 12 Urumqi Middle Road, Shanghai 200040, China. ding_hong@fudan.edu.cn
Received: February 28, 2024
Revised: May 24, 2024
Accepted: June 17, 2024
Published online: July 21, 2024
Processing time: 133 Days and 15.1 Hours
BACKGROUND
Liver stiffness (LS) measurement with two-dimensional shear wave elastography (2D-SWE) correlates with the degree of liver fibrosis and thus indirectly reflects liver function reserve. The size of the spleen increases due to tissue proliferation, fibrosis, and portal vein congestion, which can indirectly reflect the situation of liver fibrosis/cirrhosis. It was reported that the size of the spleen was related to posthepatectomy liver failure (PHLF). So far, there has been no study combining 2D-SWE measurements of LS with spleen size to predict PHLF. This prospective study aimed to investigate the utility of 2D-SWE assessing LS and spleen area (SPA) for the prediction of PHLF in hepatocellular carcinoma (HCC) patients and to develop a risk prediction model.
AIM
To investigate the utility of 2D-SWE assessing LS and SPA for the prediction of PHLF in HCC patients and to develop a risk prediction model.
METHODS
This was a multicenter observational study prospectively analyzing patients who underwent hepatectomy from October 2020 to March 2022. Within 1 wk before partial hepatectomy, ultrasound examination was performed to measure LS and SPA, and blood was drawn to evaluate the patient’s liver function and other conditions. Least absolute shrinkage and selection operator logistic regression and multivariate logistic regression analysis was applied to identify independent predictors of PHLF and develop a nomogram. Nomogram performance was validated further. The diagnostic performance of the nomogram was evaluated with receiver operating characteristic curve compared with the conventional models, including the model for end-stage liver disease (MELD) score and the albumin-bilirubin (ALBI) score.
RESULTS
A total of 562 HCC patients undergoing hepatectomy (500 in the training cohort and 62 in the validation cohort) were enrolled in this study. The independent predictors of PHLF were LS, SPA, range of resection, blood loss, international normalized ratio, and total bilirubin. Better diagnostic performance of the nomogram was obtained in the training [area under receiver operating characteristic curve (AUC): 0.833; 95% confidence interval (95%CI): 0.792-0.873; sensitivity: 83.1%; specificity: 73.5%] and validation (AUC: 0.802; 95%CI: 0.684-0.920; sensitivity: 95.5%; specificity: 52.5%) cohorts compared with the MELD score and the ALBI score.
CONCLUSION
This PHLF nomogram, mainly based on LS by 2D-SWE and SPA, was useful in predicting PHLF in HCC patients and presented better than MELD score and ALBI score.
Core Tip: Posthepatectomy liver failure (PHLF) is a major complication after hepatectomy. Liver stiffness (LS) measured by ultrasound elastography can reflect liver reserve function, while splenic enlargement can also reflect liver reserve function. Ultrasound measurement of splenic size is simple, but there were few studies that used splenic size to predict PHLF. Our study used ultrasound elastography combined with spleen size and serological indicators to establish a predictive model for PHLF. It had the potential to predict PHLF, indicating that LS, and spleen size could be used for risk stratification in patients.
