A novel preoperative predictive model of 90-day mortality after liver resection for huge hepatocellular carcinoma

Yue Yin; Jian-Wen Cheng; Fei-Yu Chen; Xu-Xiao Chen; Xin Zhang; Ao Huang; De-Zhen Guo; Yu-Peng Wang; Ya Cao; Jia Fan; Jian Zhou; Xin-Rong Yang

doi:10.21037/atm-20-7842

A novel preoperative predictive model of 90-day mortality after liver resection for huge hepatocellular carcinoma

Ann Transl Med. 2021 May;9(9):774. doi: 10.21037/atm-20-7842.

Authors

Yue Yin^{1

2}, Jian-Wen Cheng¹, Fei-Yu Chen¹, Xu-Xiao Chen¹, Xin Zhang¹, Ao Huang¹, De-Zhen Guo¹, Yu-Peng Wang¹, Ya Cao³, Jia Fan^{1

4

5}, Jian Zhou^{1

4

5}, Xin-Rong Yang¹

Affiliations

¹ Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University; Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education; Shanghai Key Laboratory of Organ Transplantation, Zhongshan Hospital, Fudan University, Shanghai, China.
² Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
³ Cancer Research Institute, Central South University; Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Changsha, China.
⁴ Institute of Biomedical Sciences, Fudan University, Shanghai, China.
⁵ State Key Laboratory of Genetic Engineering, Fudan University, Shanghai, China.

Abstract

Background: Hepatectomy for huge hepatocellular carcinoma (HCC) (diameter ≥10 cm) is characterized by high mortality. This study aimed to establish a preoperative model to evaluate the risk of postoperative 90-day mortality for huge HCC patients.

Methods: We retrospectively enrolled 1,127 consecutive patients and prospectively enrolled 93 patients with huge HCC who underwent hepatectomy (training cohort, n=798; validation cohort, n=329; prospective cohort, n=93) in our institute. Based on independent preoperative predictors of 90-day mortality, we established a logistic regression model and visualized the model by nomogram.

Results: The 90-day mortality rates were 9.6%, 9.2%, and 10.9% in the training, validation, and prospective cohort. The α-fetoprotein (AFP) level, the prealbumin levels, and the presence of portal vein tumor thrombosis (PVTT) were preoperative independent predictors of 90-day mortality. A logistic regression model, AFP-prealbumin-PVTT score (APP score), was subsequently established and showed good performance in predicting 90-day mortality (training cohort, AUC =0.87; validation cohort, AUC =0.91; prospective cohort, AUC =0.93). Using a cut-off of -1.96, the model could stratify patients into low risk (≤-1.96) and high risk (>-1.96) with different 90-day mortality rates (~30% vs. ~2%). Furthermore, the predictive performance for 90-day mortality and overall survival was significantly superior to the Child-Pugh score, the model of end-stage liver disease (MELD) score, and the albumin-bilirubin (ALBI) score.

Conclusions: The APP score can precisely predict postoperative 90-day mortality as well as long-term survival for patients with huge HCC, assisting physician selection of suitable candidates for liver resection and improving the safety and efficacy of surgical treatment.

Keywords: 90-day mortality; Hepatectomy; huge hepatocellular carcinoma; prediction.