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A simple and clinically applicable model to predict liver-related morbidity after hepatic resection for hepatocellular carcinoma

Author

Listed:
  • Jonggi Choi
  • So-Hyun Kim
  • Seungbong Han
  • Danbi Lee
  • Ju Hyun Shim
  • Young-Suk Lim
  • Han Chu Lee
  • Young-Hwa Chung
  • Yung Sang Lee
  • Sung-Gyu Lee
  • Ki-Hun Kim
  • Kang Mo Kim

Abstract

Background & aim: Hepatic resection is a treatment option for patients with hepatocellular carcinoma (HCC). However, factors associated with candidacy for resection and predictive of liver-related morbidity after resection for HCC remain unclear. This study aimed to assess candidacy for liver resection in patients with HCC and to design a model predictive of liver-related morbidity after resection. Methods: A retrospective analysis of 1,565 patients who underwent liver resection for HCC between January 2016 and December 2017 was performed. The primary outcome was liver-related morbidity, including post-hepatectomy biochemical dysfunction (PHBD), ascites, hepatic encephalopathy, rescue liver transplantation, and death from any cause within 90 days. PHBD was defined as international normalized ratio (INR) > 1.5 or hyperbilirubinemia (> 2.9 mg/dL) on postoperative day ≥ 5. Results: The 1,565 patients included 1,258 (80.4%) males and 307 (19.6%) females with a mean age of 58.3 years. Of these patients, 646 (41.3%) and 919 (58.7%) patients underwent major and minor liver resection, respectively. Liver-related morbidity was observed in 133 (8.5%) patients, including 77 and 56 patients who underwent major and minor resection, respectively. A total of 83 (5.3%) patients developed PHBD. Multivariate analysis identified cut-off values of the platelet count, serum albumin concentration, and ICG R15 value for predicting liver-related morbidity after resection. A model predicting postoperative liver-related morbidity was developed, which included seven factors: male sex, age ≥ 55 years, ICG R15 value ≥ 15%, major resection, platelet count 1.1. Conclusion: Hepatic resection for HCC was safe with 90-day liver-related morbidity and mortality rates of 8.5% and 0.8%, respectively. The developed point-based scoring system with seven factors could allow the prediction of the risk of liver-related morbidity after resection for HCC.

Suggested Citation

  • Jonggi Choi & So-Hyun Kim & Seungbong Han & Danbi Lee & Ju Hyun Shim & Young-Suk Lim & Han Chu Lee & Young-Hwa Chung & Yung Sang Lee & Sung-Gyu Lee & Ki-Hun Kim & Kang Mo Kim, 2020. "A simple and clinically applicable model to predict liver-related morbidity after hepatic resection for hepatocellular carcinoma," PLOS ONE, Public Library of Science, vol. 15(11), pages 1-15, November.
    • Handle: RePEc:plo:pone00:0241808
    DOI: 10.1371/journal.pone.0241808
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    1. van Buuren, Stef & Groothuis-Oudshoorn, Karin, 2011. "mice: Multivariate Imputation by Chained Equations in R," Journal of Statistical Software, Foundation for Open Access Statistics, vol. 45(i03).
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