Journal
JOURNAL OF GASTROINTESTINAL SURGERY
Volume 25, Issue 3, Pages 688-697Publisher
SPRINGER
DOI: 10.1007/s11605-020-04575-w
Keywords
HCC; PHLF; APRI; FLR; Hepatic functional reserve
Categories
Funding
- National Science Foundation of China Youth Fund Project [81803007]
- National Natural Science Foundation of China [81460426]
- 66th Chinese Post-Doctoral Science Foundation Project [2019M663412]
- Project of GuangXi Natural Science Foundation [2019JJA140151]
- Regional Science Fund Project of China Natural Science Foundation [81660498]
- Youth Talent Fund Project of Guangxi Natural Science Foundation [2016GXNSFBA380090, 2018GXNSFBA281030, 2018GXNSFBA281091]
- Guangxi Medical and Health Appropriate Technology Development and Application Project [S2017101, S2018062]
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The combination of APRI and sFLR showed significantly greater predictive accuracy for severe PHLF in HCC patients compared to using CP grade, MELD, APRI, or sFLR alone.
Background Accurate preoperative assessment of hepatic functional reserve is essential for conducting a safe hepatectomy. In recent years, aspartate aminotransferase-to-platelet ratio index (APRI) has been used as a noninvasive model for assessing fibrosis stage, hepatic functional reserve, and prognosis after hepatectomy with a high level of accuracy. The purpose of this research was to evaluate the clinical value of combining APRI with standardized future liver remnant (sFLR) for predicting severe post-hepatectomy liver failure (PHLF) in patients with hepatocellular carcinoma (HCC). Methods Six hundred thirty-seven HCC patients who had undergone hepatectomy were enrolled in this study. The performance of the Child-Pugh (CP) grade, model for end-stage liver disease (MELD), APRI, sFLR, and APRI-sFLR in predicting severe PHLF was assessed using the area under the ROC curve (AUC). Results Severe PHLF was found to have developed in 101 (15.9%) patients. Multivariate logistic analyses identified that prealbumin, cirrhosis, APRI score, sFLR, and major resection were significantly associated with severe PHLF. The AUC values of the CP, MELD, APRI, and sFLR were 0.626, 0.604, 0.725, and 0.787, respectively, indicating that the APRI and sFLR showed significantly greater discriminatory abilities than CP and MELD (P < 0.05 for all). After APRI was combined with sFLR, the AUC value of APRI-sFLR for severe PHLF was 0.816, which greatly improved the prediction accuracy, compared with APRI or sFLR alone (P < 0.05 for all). Stratified analysis using the status of cirrhosis and extent of resection yielded similar results. Moreover, the incidence and grade of PHLF were significantly different among the three risk groups. Conclusion The combination of APRI and sFLR can be considered to be a predictive factor with increased accuracy for severe PHLF in HCC patients, compared with CP grade, MELD, APRI, or sFLR alone.
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