A combined pre- and intra-operative nomogram in evaluation of degrees of liver cirrhosis predicts post-hepatectomy liver failure: a multicenter prospective study  

作　　者：Bin-Yong Liang Er-Lei Zhang Jian Li Xin Long Wen-Qiang Wang Bi-Xiang Zhang Zhi-Wei Zhang Yi-Fa Chen Wan-Guang Zhang Bin Mei Zhen-Yu Xiao Jin Gu Zun-Yi Zhang Shuai Xiang Han-Hua Dong Lei Zhang Peng Zhu Qi Cheng Lin Chen Zhan-Guo Zhang Bin-Hao Zhang Wei Dong Xiao-Feng Liao Tao Yin Dong-De Wu Bin Jiang Yu-Feng Yuan Zhong-Lin Zhang Yao-Bing Chen Kai-Yan Li Wan Yee Lau Xiao-Ping Chen Zhi-Yong Huang 

机构地区：[1]Hepatic Surgery Center,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,China [2]Department of General Surgery,Xiangyang Central Hospital,Affiliated Hospital of Hubei University of Arts and Science,Xiangyang,China [3]Department of Hepato-biliary Surgery,Hubei Cancer Hospital,Wuhan,China [4]Department of Hepato-pancreato-biliary Surgery Treatment Center,Taihe Hospital,Hubei University of Medicine,Shiyan,China [5]Department of Hepato-biliary Surgery,Zhongnan Hospital of Wuhan University,Wuhan,China [6]Institute of Pathology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,China [7]Department of Ultrasound,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,China [8]Faculty of Medicine,The Chinese University of Hong Kong,Prince of Wales Hospital,Shatin,N.T.,Hong Kong SAR,China

出　　处：《Hepatobiliary Surgery and Nutrition》2024年第2期198-213,I0001-I0003,共19页肝胆外科与营养（英文）

基　　金：supported by the grants from the Major Special Science and Technology Project of Hubei Province(grant number 2021BCA115);the National Science and Technology Major Project of China(grant number 2017ZX10203207-002)to Z.Y.H.;the grants from the Project of Science and Technology in Hubei Province(grant number 2018ACA137);General Project of Health Commission of Hubei Province(grant number WJ2021M108)to X.P.C.;the grant from National Natural Science Foundation of China(No.81902839)to E.L.Z.

摘　　要：Background:Adequate evaluation of degrees of liver cirrhosis is essential in surgical treatment of hepatocellular carcinoma(HCC)patients.The impact of the degrees of cirrhosis on prediction of post-hepatectomy liver failure(PHLF)remains poorly defined.This study aimed to construct and validate a combined pre-and intra-operative nomogram based on the degrees of cirrhosis in predicting PHLF in HCC patients using prospective multi-center’s data.Methods:Consecutive HCC patients who underwent hepatectomy between May 18,2019 and Dec 19,2020 were enrolled at five tertiary hospitals.Preoperative cirrhotic severity scoring(CSS)and intra-operative direct liver stiffness measurement(DSM)were performed to correlate with the Laennec histopathological grading system.The performances of the pre-operative nomogram and combined pre-and intra-operative nomogram in predicting PHLF were compared with conventional predictive models of PHLF.Results:For 327 patients in this study,histopathological studies showed the rates of HCC patients with no,mild,moderate,and severe cirrhosis were 41.9%,29.1%,22.9%,and 6.1%,respectively.Either CSS or DSM was closely correlated with histopathological stages of cirrhosis.Thirty-three(10.1%)patients developed PHLF.The 30-and 90-day mortality rates were 0.9%.Multivariate regression analysis showed four pre-operative variables[HBV-DNA level,ICG-R15,prothrombin time(PT),and CSS],and one intra-operative variable(DSM)to be independent risk factors of PHLF.The pre-operative nomogram was constructed based on these four pre-operative variables together with total bilirubin.The combined pre-and intra-operative nomogram was constructed by adding the intra-operative DSM.The pre-operative nomogram was better than the conventional models in predicting PHLF.The prediction was further improved with the combined pre-and intra-operative nomogram.Conclusions:The combined pre-and intra-operative nomogram further improved prediction of PHLF when compared with the pre-operative nomogram.

关 键 词：Cirrhosis post-hepatectomy liver failure(PHLF) HEPATECTOMY NOMOGRAM hepatocellular carcinoma(HCC) 

分 类 号：R575.2[医药卫生—消化系统] R575.3[医药卫生—内科学]