A Novel Nomogram for Prediction of Post-Hepatectomy Liver Failure in Patients with Resectable Hepatocellular Carcinoma: A Multicenter Study

Abstract

Jitao Wang,1,2,* Zhanguo Zhang,3,* Dong Shang,4,* Yong Liao,2,* Peng Yu,5,* Jinling Li,2 Shubo Chen,2 Dengxiang Liu,2 Hongrui Miao,3 Shuang Li,4 Biao Zhang,4 Anliang Huang,4 Hao Liu,6 Yewei Zhang,7 Xiaolong Qi1 1Center of Portal Hypertension, Department of Radiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, People’s Republic of China; 2Xingtai Key Laboratory of Precision Medicine for Liver Cirrhosis and Portal Hypertension, Xingtai People’s Hospital of Hebei Medical University, Xingtai, People’s Republic of China; 3Hepatic Surgery Center, Tongji Hospital, Tongji Hospital Affiliated to Huazhong University of Science and Technology, Wuhan, People’s Republic of China; 4Department of Hepatobiliary Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China; 5Department of Hepatobiliary Surgery, Fifth Medical Center of PLA General Hospital, Beijing, People’s Republic of China; 6Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; 7Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xiaolong Qi, Center of Portal Hypertension, Department of Radiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, People’s Republic of China, Email [email protected] Jitao Wang, Xingtai Key Laboratory of Precision Medicine for Liver Cirrhosis and Portal Hypertension, Xingtai People’s Hospital of Hebei Medical University, Xingtai, Hebei, People’s Republic of China, Email [email protected]: To develop a nomogram for predicting post-hepatectomy liver failure (PHLF) in patients with resectable hepatocellular carcinoma (HCC) based on portal hypertension, the extent of resection, ALT, total bilirubin, and platelet count.Methods: Patients with HCC hospitalized from January 2015 to December 2020 were included in a retrospective cohort study. 595 HCC patients were divided into a training cohort (n=416) and a validation cohort (n=179) by random sampling. Univariate and multivariable analyses were performed to identify the independent variables to predict PHLF. The nomogram models for predicting the overall risk of PHLF and the risk of PHLF B+C were constructed based on the independent variables. Comparisons were made by using receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) with traditional models, such as FIB-4 score, APRI score, CP class (Child-Pugh), MELD score (model of end-stage liver disease), and ALBI score (albumin-bilirubin) to analyze the accuracy and superiority of the nomogram.Results: We discovered that portal hypertension (yes vs no) (OR=1.677,95% CI:1.817– 4.083, p=0.002), the extent of liver resection (OR=1.872,95% CI:3.937– 47.096, p=0.001), ALT (OR=1.003,95% CI:1.003– 1.016, P=0.003), total bilirubin (OR=1.036,95% CI:1.031– 1.184, p=0.005), and platelet count (OR= 1.004, 95% CI:0.982– 0.998, p=0.020) were independent risk factors for PHLF using multifactorial analysis. The nomogram models were constructed using well-fit calibration curves for each of these five covariates. When compared to the FIB4, ALBI, MELD, and CP score, our nomogram models have a better predictive value for predicting the overall risk of PHLF or the risk of PHLF B+C. The validation cohort’s results were consistent. DCA also confirmed the conclusion.Conclusion: Our models, in the form of static nomogram or web application, were developed to predict PHLF overall risk and PHLF B+C risk in patients with HCC, with a high prediction sensitivity and specificity performance than other commonly used scoring systems.Keywords: post-hepatectomy liver failure, hepatocellular carcinoma, nomogram, predictive model

Keywords

• post-hepatectomy liver failure
• hepatocellular carcinoma
• nomogram
• predictive model