End-stage liver disease score and future liver remnant volume predict post-hepatectomy liver failure in hepatocellular carcinoma

Table 1 Patient characteristics in the two groups

Variable	PHLF (+) (n = 20)	PHLF (-) (n = 218)	P value
Age, years	57 (26-66)	51 (18-74)	0.077
Gender ratio, M/F	16/4	189/29	0.407
Platelet count, ×109/L	123 (28-240)	158 (30-535)	0.016
Prothrombin time, s	13.9 (10.8-16.4)	13.1 (9.9-17.1)	0.289
International normalized ratio	1.06 (1.00-1.26)	1.06 (0.88-1.44)	0.971
Total bilirubin, μmol/L	20.1 (6.2-43.1)	12.9 (3.9-37.1)	0.001
Albumin, g/L	37.3 (26.1-43.3)	38.8 (25.6-48.9)	0.029
Alanine aminotransferase, U/L	46.2 (16.9-94.7)	34.1 (8.5-302.6)	0.127
HBsAg positivity	90.0%	92.7%	0.667
Maximum tumor size, cm	6.5 (2.5-13.3)	5.5 (1.5-18.0)	0.270
sFLR	0.503 (0.378-0.780)	0.666 (0.361-0.995)	< 0.001
Major hepatectomy	40.0%	25.2%	0.152
MELD score	9 (6-12)	7 (6-12)	0.001

Date are presented as median (range) if not specified. PHLF: Post-hepatectomy liver failure; MELD: Model for end-stage liver disease; sFLR: Standardized future liver remnant.

Table 2 Univariable and multivariable analyses to identify predictors of post-hepatectomy liver failure

Variable	Univariate analysis		Multivariate analysis
	Odds ratio	P value	Odds ratio	P value
Age, years	1.60 (0.58-4.40)	0.360	3.02 (0.77-11.78)	0.112
Male sex	0.61 (0.19-1.96)	0.411	0.68 (0.15-3.07)	0.616
Platelet count, ×109/L	2.97 (1.14-7.73)	0.026	5.17 (1.31-20.35)	0.019
Blood loss, mL	2.27 (0.87-5.92)	0.092	1.14 (0.33-3.91)	0.839
Tumor number (≥ 3)	0.58 (0.13-2.62)	0.479	0.31 (0.05-2.14)	0.235
Albumin, g/L	3.67 (1.29-10.46)	0.015	3.90 (1.14-13.35)	0.030
Prothrombin time, s	1.45 (0.57-3.68)	0.439	1.39 (0.40-4.82)	0.605
sFLR	10.08 (3.49-29.10)	< 0.001	29.92 (6.51-137.46)	< 0.001
MELD	5.98 (2.31-15.45)	< 0.001	7.89 (2.23-28.01)	0.001

sFLR: Standardized future liver remnant; MELD: Model for end-stage liver disease.

Table 3 Prognostic value of various indexes to predict post-hepatectomy liver failure

Index	AUC	95%CI	Cut-off value	P value	Sensitivity (%)	Specificity (%)
MELD	0.715	0.581-0.849	8.5	0.001	55.0	83.0
sFLR	0.782	0.687-0.877	0.544	< 0.001	77.1	75.0
sFLR/MELD	0.845	0.778-0.912	0.078	< 0.001	66.5	95.0

AUC: Area under the curve; CI: Confidence interval; MELD: Model for end-stage liver disease; sFLR: Standardized future liver remnant.

Table 4 Comparison of post-hepatectomy liver failure based on the cut-off value of standardized future liver remnant /model for end-stage liver disease

Group	n	PHLF (+)	PHLF (-)
sFLR/MELD ≥ 0.078	146	19	127
sFLR/MELD < 0.078	92	1	91

χ² = 9.065, P = 0.001. PHLF: Post-hepatectomy liver failure; MELD: Model for end-stage liver disease; sFLR: Standardized future liver remnant.