Prediction of post-hepatectomy liver failure and long-term prognosis after curative resection of hepatocellular carcinoma using liver stiffness measurement

Background and study aims: Post-hepatectomy liver failure (PHLF) is the main cause of perioperative death after hepatocellular carcinoma (HCC) resection. PHLF occurrence is related to both the hepatec-tomy volume and the degree of cirrhosis. Accurate preoperative assessment of the degree of cirrhosis may aid in reducing the incidence of PHLF. Several studies have shown that the liver stiffness measure-ment (LSM) is well correlated with cirrhosis. This study explored the relationship between LSM and PHLF occurrence after radical HCC resection and the effect on long-term prognosis. Patients and methods: We retrospectively analyzed the clinical data of 164 patients who underwent rad-ical HCC resection at our center from January 2017 to January 2020. The related postoperative PHLF fac-tors were analyzed. The LSM threshold in postoperative PHLF was calculated through receiver operating characteristic (ROC) curve analysis. Patients were grouped according to different LSM thresholds and sur-vival analysis was performed. Results: Forty-six patients experienced PHLF, of whom 19, 21, and 6 were classified as grades A, B, and C, respectively. Multivariate analysis indicated that LSM was an independent risk factor for PHLF after HCC surgery (OR = 1.174, P < 0.000). LSM (OR = 1.219, P < 0.000) and intraoperative bleeding (OR = 1.001, P = 0.047) were risk factors for grade B-C PHLF. The LSM threshold that predicted PHLF occurrence was 17.9 kPa (AUC = 0.831, P < 0.000) and 24.5 kPa (AUC = 0.867, P < 0.000) for grade B-C PHLF. LSM was correlated with PHLF severity (r = 0.439, P < 0.001). The median survival times were 32 vs 26 months (P = 0.016) for patients with LSM < 17.9 kPa vs those with LSM > 17.9 kPa and 28 vs 24 months (P = 0.004) for patients with LSM < 24.5 kPa vs those with LSM > 24.5 kPa. Conclusion: LSM is related to PHLF occurrence in patients undergoing HCC resection; a higher LSM is associated with the occurrence of more severe PHLF after surgery. In addition, LSM may aid in predicting long-term survival after liver resection in patients with HCC.(c) 2022 Pan-Arab Association of Gastroenterology. Published by Elsevier B.V. All rights reserved.

Automated summary

This study found that liver stiffness measurement (LSM) is related to the occurrence of post-hepatectomy liver failure (PHLF) after hepatocellular carcinoma (HCC) surgery. Patients with higher LSM levels may have a higher risk of developing more severe PHLF after surgery. Additionally, LSM may aid in predicting long-term survival after liver resection in patients with HCC.