Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 26, 2019; 7(22): 3734-3741
Published online Nov 26, 2019. doi: 10.12998/wjcc.v7.i22.3734
End-stage liver disease score and future liver remnant volume predict post-hepatectomy liver failure in hepatocellular carcinoma
Fan-Hua Kong, Xiong-Ying Miao, Heng Zou, Li Xiong, Yu Wen, Bo Chen, Xi Liu, Jiang-Jiao Zhou
Fan-Hua Kong, Xiong-Ying Miao, Heng Zou, Li Xiong, Yu Wen, Bo Chen, Xi Liu, Jiang-Jiao Zhou, Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
Author contributions: All authors helped to perform the research; Kong FH wrote the manuscript, performed the procedures, and analyzed the data; Miao XY performed the experiments; Zou H, Xiong L, Wen Y, Chen B, and Liu X contributed to the writing of the manuscript; Zhou JJ contributed to the writing of the manuscript and drafted the conception and design.
Supported by the National Natural Science Foundation of China, No. 81970569, No. 81773293, and No. 31660266; Natural Science Foundation of Hunan Province, No. 2015JJ4083, No. 2019JJ50874, and No. 2018JJ3758.
Institutional review board statement: This research was approved by the Central South University Agency Review Committee.
Informed consent statement: The patients were not required to give informed consent to the study because the analysis used anonymous clinical data.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this article.
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/
Corresponding author: Jiang-Jiao Zhou, MD, Doctor, Department of General Surgery, The Second Xiangya Hospital, Central South University, Renming Road, Changsha 410011, Hunan Province, China. zhoujiangjiao@csu.edu.cn
Telephone: +86-13974966913
Received: September 3, 2019
Peer-review started: September 3, 2019
First decision: September 23, 2019
Revised: October 18, 2019
Accepted: October 30, 2019
Article in press: October 29, 2019
Published online: November 26, 2019
Abstract
BACKGROUND

Hepatocellular carcinoma (HCC) is the world’s sixth most common malignant tumor and the third cause of cancer death. Although great progress has been made in hepatectomy, it is still associated with a certain degree of risk of post-hepatectomy liver failure (PHLF), which extends the length of hospital stay and remains the leading cause of postoperative death. Studies have shown that assessment of hepatic functional reserve before hepatectomy is beneficial for reducing the incidence of PHLF.

AIM

To assess the value of model for end-stage liver disease (MELD) score combined with standardized future liver remnant (sFLR) volume in predicting PHLF in patients undergoing hepatectomy for HCC.

METHODS

This study was attended by 238 patients with HCC who underwent hepatectomy between January 2015 and January 2018. Discrimination of sFLR volume, MELD score, and sFLR/MELD ratio to predict PHLF was evaluated according to the area under the receiver operating characteristic curve.

RESULTS

The patients were divided into two groups according to whether PHLF occurred after hepatectomy. The incidence of PHLF was 8.4% in our research. The incidence of PHLF increased with the decrease in sFLR volume and the increase in MELD score. Both sFLR volume and MELD score were considered independent predictive factors for PHLF. Moreover, the cut-off value of the sFLR/MELD score to predict PHLF was 0.078 (P < 0.001). This suggests that an sFLR/MELD ≥ 0.078 indicates a higher incidence of PHLF than an sFLR/MELD < 0.078.

CONCLUSION

MELD combined with sFLR is a reliable and effective PHLF predictor, which is superior to MELD score or sFLR volume alone.

Keywords: Post-hepatectomy liver failure, Hepatocellular carcinoma, Hepatectomy, Model for end-stage liver disease, Standardized future liver remnant, Hepatitis B virus

Core tip: Hepatocellular carcinoma (HCC) is the sixth most common malignancy and the second leading cause of death from cancer worldwide. At present, Post-hepatectomy liver failure (PHLF) is still one of the main causes of death for HCC patients undergoing hepatectomy. Although standardized future liver remnant (sFLR) or model for end-stage liver disease (MELD) can predict the occurrence of PHLF to a certain extent, their sensitivity and specificity do not sufficiently meet clinical needs. The combination of sFLR volume with MELD score is a reliable predictor of PHLF. This measurement can effectively guide the early management after hepatectomy, thereby improving the prognosis and reducing the mortality. Also, the model can provide a new strategy for the preoperative evaluation of hepatectomy.