Kuang TZ, Xiao M, Liu YF. Predictive value of NLR, Fib4, and APRI in the occurrence of liver failure after hepatectomy in patients with hepatocellular carcinoma. World J Gastrointest Surg 2024; 16(1): 155-165 [PMID: 38328329 DOI: 10.4240/wjgs.v16.i1.155]
Corresponding Author of This Article
Yong-Fan Liu, MM, PhD, Associate Chief Physician, Department of Hepatobiliary Surgery, Ji’an Central People’s Hospital, No. 106 Jinggangshan Avenue, Ji’an 343000, Jiangxi Province, China. lyfsh268@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
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/
World J Gastrointest Surg. Jan 27, 2024; 16(1): 155-165 Published online Jan 27, 2024. doi: 10.4240/wjgs.v16.i1.155
Predictive value of NLR, Fib4, and APRI in the occurrence of liver failure after hepatectomy in patients with hepatocellular carcinoma
Tian-Zuo Kuang, Meng Xiao, Yong-Fan Liu
Tian-Zuo Kuang, Meng Xiao, Yong-Fan Liu, Department of Hepatobiliary Surgery, Ji’an Central People’s Hospital, Ji’an 343000, Jiangxi Province, China
Author contributions: Kuang TZ contributed to investigation, software, data curation, formal analysis, and writing-original draft; Xiao M contributed to methodology, supervision, and validation; Liu YF contributed to conceptualization, resources, writing-review, and editing.
Institutional review board statement: The study was reviewed and approved by the Medical Ethics Committee of Ji’an Central People’s Hospital. Institutional Review Board (Approval No. 2021-L121201).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: No additional data are available.
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: Yong-Fan Liu, MM, PhD, Associate Chief Physician, Department of Hepatobiliary Surgery, Ji’an Central People’s Hospital, No. 106 Jinggangshan Avenue, Ji’an 343000, Jiangxi Province, China. lyfsh268@163.com
Received: November 30, 2023 Peer-review started: November 30, 2023 First decision: December 18, 2023 Revised: December 21, 2023 Accepted: January 5, 2024 Article in press: January 5, 2024 Published online: January 27, 2024 Processing time: 55 Days and 21.4 Hours
Abstract
BACKGROUND
Neutrophil-lymphocyte ratio (NLR), fibrosis index based on four factors (Fib4), aspartate aminotransferase-to-platelet ratio index (APRI) can be used for prognostic evaluation of hepatocellular carcinoma. However, no study has established an individualized prediction model for the prognosis of hepatocellular carcinoma based on these factors.
AIM
To screen the factors that affect the prognosis of hepatocellular carcinoma and establish a nomogram model that predicts postoperative liver failure after hepatic resection in patients with hepatocellular carcinoma.
METHODS
In total, 220 patients with hepatocellular carcinoma treated in our hospital from January 2022 to January 2023 were selected. They were divided into 154 participants in the modeling cohort, and 66 in the validation cohort. Comparative analysis of the changes in NLR, Fib4, and APRI levels in 154 patients with hepatocellular carcinoma before liver resection and at 3 mo, 6 mo, and 12 mo postoperatively was conducted. Binary logistic regression to analyze the influencing factors on the occurrence of liver failure in hepatocellular carcinoma patients, roadmap prediction modeling, and validation, patient work characteristic curves (ROCs) to evaluate the predictive efficacy of the model, calibration curves to assess the consistency, and decision curve analysis (DCA) to evaluate the model’s validity were also conducted.
RESULTS
Binary logistic regression showed that Child-Pugh grading, Surgical site, NLR, Fib4, and APRI were all risk factors for liver failure after hepatic resection in patients with hepatocellular carcinoma. The modeling cohort built a column-line graph model, and the area under the ROC curve was 0.986 [95% confidence interval (CI): 0.963-1.000]. The patients in the validation cohort utilized the column-line graph to predict the probability of survival in the validation cohort and plotted the ROC curve with an area under the curve of the model of 0.692 (95%CI: 0.548-0.837). The deviation of the actual outcome curves from the calibration curves of the column-line plots generated by the modeling and validation cohorts was small, and the DCA confirmed the validity.
CONCLUSION
NLR, Fib4, and APRI independently influence posthepatectomy liver failure in patients with hepatocellular carcinoma. The column-line graph prediction model exhibited strong prognostic capability, with substantial concordance between predicted and actual events.
Core Tip: Postoperative liver failure in hepatocellular carcinoma is a serious complication that seriously affects the survival and quality of life of patients. Our work showed that neutrophil-lymphocyte ratio, fibrosis index based on four factors, and aspartate aminotransferase-to-platelet ratio index independently influenced the occurrence of liver failure following hepatectomy in patients with hepatocellular carcinoma. The column-line graph prediction model constructed in this study for the occurrence of liver failure after hepatectomy in patients with hepatocellular carcinoma showed good predictive ability, and the consistency between the predicted and actual events was high. This model has broad potential as a tool to prevent liver failure after hepatectomy in patients with hepatocellular carcinoma.
