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
Processing time: 83 Days and 23.8 Hours
ARTICLE HIGHLIGHTS
Research background

Hepatocellular carcinoma (HCC) is the most frequent primary liver cancer. HCC predominantly develops in patients with liver cirrhosis. At present, hepatectomy is still the main treatment for HCC. However, post-hepatectomy liver failure (PHLF) is one of the most serious complications following hepatic resection, despite improvements in surgical and post-operative management. Thus, it is of great clinical significance to evaluate the risk of PHLF before operation to reduce its incidence after hepatectomy.

Research motivation

At present, the models of predicting the occurrence of PHLF after hepatectomy do not meet the clinical needs. We need to have new forecasting indicators to further improve the models for predicting the occurrence of PHLF. The purpose of our study was to evaluate 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 liver cancer.

Research objectives

To study the value of MELD score combined with sFLR volume in predicting PHLF in patients undergoing hepatectomy for HCC, and explore the application of sFLR/MELD score in the hepatectomy and treatment of HCC, so as to provide reference for clinical treatment of this malignancy.

Research methods

A total of 238 patients with HCC treated at our hospital from January 2015 to January 2018 were selected as a study group. Discrimination of sFLR volume, MELD score, and sFLR/MELD ratio to predict PHLF was evaluated according to the univariable and multivariable analyses, χ2 test, and receiver operating characteristic curve analysis.

Research results

The incidence of PHLF increased with the decrease of sFLR volume and the increase of MELD score. Moreover, both sFLR volume and MELD score were independent risk factors for PHLF. The cut-off value of the sFLR/MELD score to predict PHLF was 0.078, with an AUC of 0.845, which was superior to MELD score or sFLR volume alone.

Research conclusions

sFLR volume combined with MELD score can effectively guide early treatment after hepatectomy, so as to improve prognosis and reduce mortality. The model also provides a new strategy for preoperative evaluation of hepatectomy.

Research perspectives

Future studies are needed to further confirm the relationship between sFLR/MELD score and patient survival rate so that it can be better used in clinical practice. What’s more, to further consummate the follow-up time of patients and improve the accuracy of sFLR/MELD score is the next step for further analysis.