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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Association of preoperative antiviral treatment with incidences of post-hepatectomy liver failure in hepatitis B virus-related hepatocellular carcinoma
Xiao Wang, Zhao-Yi Lin, You Zhou, Qin Zhong, Zong-Ren Li, Xi-Xiang Lin, Ming-Gen Hu, Kun-Lun He
Xiao Wang, You Zhou, Qin Zhong, Zong-Ren Li, Xi-Xiang Lin, Kun-Lun He, Medical Big Data Research Center, Chinese PLA General Hospital, Beijing 100853, China
Xiao Wang, Zhao-Yi Lin, Qin Zhong, Zong-Ren Li, Xi-Xiang Lin, Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing 100853, China
Xiao Wang, Department of Hepatobiliary Surgery, Chinese PLA 970th Hospital, Yantai 264001, Shandong Province, China
Zhao-Yi Lin, Ming-Gen Hu, Faculty of Hepato-Pancreato-Biliary Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
You Zhou, School of Medicine, Nankai University, Tianjin 300071, China
Co-first authors: Xiao Wang and Zhao-Yi Lin.
Co-corresponding authors: Ming-Gen Hu and Kun-Lun He.
Author contributions: Wang X, Lin ZY, Hu MG and He KL conceptualized and designed the research study; Wang X, Lin ZY, Zhong Q, Li ZR and Lin XX performed data collection and collation; Wang X, Lin ZY and Zhou Y completed data analysis; Wang X and Lin ZY contributed to the writing of the original manuscript; Hu MG and He KL supervised the research process and revised the manuscript; All authors have read and approved the final submitted version of the manuscript. Wang X proposed and designed the research approach, performed data analysis and prepared the first draft of the manuscript. Lin ZY was mainly responsible for patient screening and collection of clinical data. Both authors have made crucial contributions towards the completion of the project and thus qualified as the co-first authors of the paper. Both He KL and Hu MG have played indispensable roles in the experimental design, data interpretation and manuscript preparation as the co-corresponding authors. He KL applied for and obtained the funds for this research project. He KL conceptualized, designed, and supervised the whole process of the project. He searched the literature, revised and submitted the early version of the manuscript with the focus on the association between antiviral therapy and post-hepatectomy liver failure. Hu MG was instrumental for comprehensive literature search, preparation and submission of the current version of the manuscript with a focus on hepatitis B virus DNA level as a predictor of post-hepatectomy liver failure. This collaboration between He KL and Hu MG is crucial for the publication of this manuscript.
Supported by Science and Technology Innovation 2030 - Major Project, No. 2021ZD0140406 and No. 2021ZD0140401.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Chinese PLA General Hospital (No. S2022-766-01).
Informed consent statement: The informed consent has been waived by the Medical Ethics Committee of Chinese PLA General Hospital.
Conflict-of-interest statement: All the authors declare no competing interests for this article.
Data sharing statement: All data generated or analyzed during this study were included in this published article. The informed consent was not obtained but the presented data are anonymized and risk of identification is low. The original clinical data used in this study can be available with the approval of the corresponding author at
hekunlun301dr@163.com.
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: Kun-Lun He, MD, Chief Physician, Professor, Medical Big Data Research Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China.
hekunlun301dr@163.com
Received: March 12, 2024
Revised: June 3, 2024
Accepted: June 20, 2024
Published online: July 27, 2024
Processing time: 132 Days and 1.9 Hours
BACKGROUND
Post-hepatectomy liver failure (PHLF) is a common consequence of radical partial hepatectomy in hepatocellular carcinoma (HCC).
AIMS
To investigate the relationship between preoperative antiviral therapy and PHLF, as well as assess the potential efficacy of hepatitis B virus (HBV) DNA level in predicting PHLF.
METHODS
A retrospective study was performed involving 1301 HCC patients with HBV who underwent radical hepatectomy. Receiver operating characteristic (ROC) analysis was used to assess the capacity of HBV DNA to predict PHLF and establish the optimal cutoff value for subsequent analyses. Logistic regression analyses were performed to assess the independent risk factors of PHLF. The increase in the area under the ROC curve, categorical net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were used to quantify the efficacy of HBV DNA level for predicting PHLF. The P < 0.05 was considered statistically significant.
RESULTS
Logistic regression analyses showed that preoperative antiviral therapy was independently associated with a reduced risk of PHLF (P < 0.05). HBV DNA level with an optimal cutoff value of 269 IU/mL (P < 0.001) was an independent risk factor of PHLF. All the reference models by adding the variable of HBV DNA level had an improvement in area under the curve, categorical NRI, and IDI, particularly for the fibrosis-4 model, with values of 0.729 (95%CI: 0.705-0.754), 1.382 (95%CI: 1.341-1.423), and 0.112 (95%CI: 0.110-0.114), respectively. All the above findings were statistically significant.
CONCLUSION
In summary, preoperative antiviral treatment can reduce the incidence of PHLF, whereas an increased preoperative HBV DNA level has a correlative relationship with an increased susceptibility to PHLF.
Core Tip: The correlation between preoperative antiviral treatment and post-hepatectomy liver failure (PHLF), hepatitis B virus (HBV) DNA level, and PHLF were analyzed through univariate and multivariate logistic regression analyses, respectively. The optimal cut-off value of HBV DNA was determined through Receiver operating characteristic (ROC) curve analysis. Based on three conventional scoring models, the efficacy of HBV DNA level in predicting PHLF was quantified by computing the area under the ROC curve, categorical net reclassification improvement, and integrated discrimination improvement.
