A nomogram for prediction of posthepatectomy liver failure in patients with hepatocellular carcinoma: A retrospective study

Medicine (Baltimore). 2019 Dec;98(51):e18490. doi: 10.1097/MD.0000000000018490.

Abstract

To generate a nomogram to predict posthepatectomy liver failure (PHLF), we attempted to elucidate salient risk factors in patients with hepatocellular carcinoma (HCC).We performed a retrospective review of 665 patients with HCC who received hepatectomy in 2 academic institutions in China. Independent risk factors for PHLF were identified from putative demographic, intrinsic, biochemical, surgery-related, and volumetric data. A predictive nomogram was formulated based on relevant risk factors, and we compared this with existing models.We identified clinical signs of portal hypertension (P = .023), serum total bilirubin (P = .001), serum creatinine (P = .039), and intraoperative hemorrhage (P = .015) as being important risk factors in predicting PHLF. The nomogram had a C-index of 0.906 for the externally validated data. The nomogram displayed better predictive value than 2 of the other most cited models (C-indices of 0.641 and 0.616, respectively) in the current cohort. Additionally, we were able to patients into low- (<10%), intermediate- (10-30%), and high-risk (≥30%) groups based on the nomogram. This allows us to facilitate person-specific management.Here, we constructed a simple nomogram for prediction of PHLF in patients with HCC weighted by independent risk factors. Further prospective studies are required to confirm the predictive ability of our nomogram.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Carcinoma, Hepatocellular / surgery*
  • China / epidemiology
  • Female
  • Hepatectomy / adverse effects*
  • Humans
  • Liver Failure / epidemiology*
  • Liver Failure / etiology
  • Liver Neoplasms / surgery*
  • Male
  • Middle Aged
  • Nomograms
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / etiology
  • Retrospective Studies