Albumin-indocyanine green evaluation of future liver remnant predicts liver failure after anatomical hepatectomy for hepatocellular carcinoma: A dual-center retrospective study

IF 2.9 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Annals of Gastroenterological Surgery Pub Date : 2023-09-22 DOI:10.1002/ags3.12743

Tomoyuki Nagaoka, Kohei Ogawa, Katsunori Sakamoto, Taro Nakamura, Yoshinori Imai, Yusuke Nishi, Masahiko Honjo, Kei Tamura, Naotake Funamizu, Yasutsugu Takada

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Abstract

Aim

The albumin-indocyanine green evaluation (ALICE) score is a useful predictor of post-hepatectomy liver failure (PHLF); however, its usefulness in combination with future liver remnant (FLR), measured by 3-D volumetry, has not been investigated. This study aimed to investigate the relationship between the ALICE of the FLR (ALICE-FLR) score and severe PHLF.

Methods

The clinical data of 215 patients who underwent anatomical hepatectomy for hepatocellular carcinoma without portal vein embolization at two institutes between January 2010 and December 2021 were analyzed retrospectively. PHLF occurrence and severity were determined according to the International Study Group of Liver Surgery's definition. Grades B and C PHLF were defined as severe PHLF. The ALICE-FLR, ALICE scores, and indocyanine green clearance of FLR (ICGK-FLR) were evaluated for severe PHLF prediction.

Results

Severe PHLF was observed in 40 patients (18.6%). The areas under the curve (AUCs) for the ALICE-FLR, ALICE scores, ICGK-FLR, and FLR were 0.76, 0.64, 0.73, and 0.69, respectively. The AUC of the ALICE-FLR score was significantly higher than that of the ALICE score. The ALICE-FLR score was identified as an independent predictor of severe PHLF (the odds ratio for every 0.01 increment in the ALICE-FLR score was 1.24; 95% confidence interval, 1.070–1.453; p = 0.004). Among patients with severe PHLF, the ALICE-FLR score was significantly higher in the grade C than in the grade B PHLF group.

Conclusion

The combination of liver function models, including indocyanine green, albumin, and FLR is considered compatible for predicting severe PHLF.

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解剖性肝切除术治疗肝细胞癌后，白蛋白-靛氰绿对未来残肝的评估可预测肝功能衰竭：一项双中心回顾性研究

目的白蛋白-靛青绿评估（ALICE）评分是预测肝切除术后肝功能衰竭（PHLF）的有效指标，但其与通过三维容积测量法测量的未来肝残余（FLR）的结合是否有用，尚未进行研究。本研究旨在探讨FLR的ALICE（ALICE-FLR）评分与重度PHLF之间的关系。方法回顾性分析了 2010 年 1 月至 2021 年 12 月期间在两家医院接受解剖性肝切除术治疗肝细胞癌且未进行门静脉栓塞的 215 例患者的临床数据。PHLF的发生和严重程度根据国际肝脏外科研究小组的定义确定。B 级和 C 级 PHLF 被定义为严重 PHLF。评估了ALICE-FLR、ALICE评分和FLR的吲哚青绿清除率（ICGK-FLR），以预测重度PHLF。结果 40 例患者（18.6%）出现严重 PHLF。ALICE-FLR、ALICE评分、ICGK-FLR和FLR的曲线下面积（AUC）分别为0.76、0.64、0.73和0.69。ALICE-FLR 评分的 AUC 明显高于 ALICE 评分。ALICE-FLR评分被确定为重度PHLF的独立预测因子（ALICE-FLR评分每增加0.01，几率比为1.24；95%置信区间为1.070-1.453；P = 0.004）。在重度 PHLF 患者中，C 级 PHLF 组的 ALICE-FLR 评分明显高于 B 级 PHLF 组。结论包括吲哚菁绿、白蛋白和 FLR 在内的肝功能模型组合可用于预测重度 PHLF。

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