Risk factors and nomogram model construction of post-hepatectomy liver failure for hepatocellular carcinoma

doi:10.3877/cma.j.issn.2095-3232.2024.03.006

Abstract

Abstract:

Objective

To identify the risk factors of post-hepatectomy liver failure (PHLF) in patients with hepatocellular carcinoma (HCC), and to construct a nomogram prediction model for PHLF.

Methods

Clinical data of 188 patients with HCC who underwent radical hepatectomy in the Third Affiliated Hospital of Sun Yat-sen University from January 2022 to April 2023 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 165 patients were male and 23 female, aged from 24 to 75 years, with a median age of 55 years. The independent risk factors of PHLF were determined by Logistic regression analysis. The nomogram model was constructed. The discrimination and calibration degree of the model were evaluated by using the area under the ROC curve (AUC) and calibration curve. The constructed model was compared with the actual score of comprehensive liver function.

Results

The incidence of PHLF was 25%(47/188), including3 cases of grade A PHLF, 42 cases of grade B and 2 cases of grade C, and one of them died of PHLF. Logistic regression analysis showed that ALT (OR=1.037, 95%CI: 1.007-1.068), TB (OR=1.176, 95%CI: 1.013-1.365), maximal tumor diameter (OR=1.414, 95%CI: 1.148-1.742), ALBI score (OR=0.173, 95%CI: 0.031-0.962) and ICGR15 (OR=1.081, 95%CI: 1.005-1.162) were the independent risk factors for PHLF (P<0.05). Based on ALT, ICGR15, TB and maximal tumor diameter (ARTL), the AUC of ARTL model was 0.816 (95%CI: 0.747-0.885), indicating it had high predictive capability. The calibration curve and calibration prediction curve fit well, and the predicted value was in high agreement with the observed value. The predictive efficiency and clinical benefit of ARTL model were better than those of ALBI score (AUC=0.607), FIB-4 index (AUC=0.672) and APRI score (AUC=0.730).

Conclusions

ALT, ICGR15, TB, maximal tumor diameter and ALBI score are the independent risk factors for PHLF. ARTL model has high predictive capability, which is superior to the existing three comprehensive scoring systems for liver function.

Key words: Hepatectomy, Carcinoma, hepatocellular, Liver failure, Nomogram

Zaomao Zhong, Wenchao Luo, Manhang Cai, Xianyu Chen, Yuesi Zhong. Risk factors and nomogram model construction of post-hepatectomy liver failure for hepatocellular carcinoma[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(03): 289-295.

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References 29

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变量	单因素分析				多因素分析
变量	b	OR	95%CI	P	b	OR	95%CI	P
PLT	-0.007	0.993	0.987～0.998	0.006	-0.005	0.995	0.986～1.003	0.218
ALT	0.023	1.024	1.008～1.040	0.003	0.037	1.037	1.007～1.068	0.014
AST	0.018	1.018	1.001～1.036	0.039	0.000	1.000	0.983～1.017	0.994
胆碱酯酶	0.000	1.000	0.999～1.000	0.001	0.000	1.000	0.999～1.000	0.189
TB	0.157	1.170	1.091～1.256	< 0.001	0.162	1.176	1.013～1.365	0.033
DB	0.536	1.709	1.370～2.133	< 0.001	0.033	1.034	0.632～1.691	0.894
肿瘤长径	0.139	1.149	1.017～1.298	0.025	0.347	1.414	1.148～1.742	0.001
ALBI	1.200	3.320	1.206～9.141	0.020	-1.752	0.173	0.031～0.962	0.045
APRI	0.980	2.663	1.549～4.579	< 0.001	-1.175	0.180	0.016～2.054	0.167
FIB-4	0.306	1.357	1.133～1.626	< 0.001	0.372	1.451	0.777～2.710	0.243
ICGR15	0.085	1.089	1.040～1.140	< 0.001	0.078	1.081	1.005～1.162	0.035
术中输血	0.758	2.134	1.092～4.168	0.027	0.501	1.650	0.695～3.919	0.256

变量	单因素分析				多因素分析
变量	b	OR	95%CI	P	b	OR	95%CI	P
PLT	-0.007	0.993	0.987～0.998	0.006	-0.005	0.995	0.986～1.003	0.218
ALT	0.023	1.024	1.008～1.040	0.003	0.037	1.037	1.007～1.068	0.014
AST	0.018	1.018	1.001～1.036	0.039	0.000	1.000	0.983～1.017	0.994
胆碱酯酶	0.000	1.000	0.999～1.000	0.001	0.000	1.000	0.999～1.000	0.189
TB	0.157	1.170	1.091～1.256	< 0.001	0.162	1.176	1.013～1.365	0.033
DB	0.536	1.709	1.370～2.133	< 0.001	0.033	1.034	0.632～1.691	0.894
肿瘤长径	0.139	1.149	1.017～1.298	0.025	0.347	1.414	1.148～1.742	0.001
ALBI	1.200	3.320	1.206～9.141	0.020	-1.752	0.173	0.031～0.962	0.045
APRI	0.980	2.663	1.549～4.579	< 0.001	-1.175	0.180	0.016～2.054	0.167
FIB-4	0.306	1.357	1.133～1.626	< 0.001	0.372	1.451	0.777～2.710	0.243
ICGR15	0.085	1.089	1.040～1.140	< 0.001	0.078	1.081	1.005～1.162	0.035
术中输血	0.758	2.134	1.092～4.168	0.027	0.501	1.650	0.695～3.919	0.256

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