Abstract:

Objective

To assess the predictive value of indocyanine green retention rate at 15 min （ICGR15） and albumin-bilirubin （ALBI） score for post-hepatectomy liver failure（PHLF） and prognosis of hepatocellular carcinoma （HCC） patients after hepatic arterial infusion chemotherapy （HAIC）.

Methods

Clinical data of 160 HCC patients who underwent hepatectomy after HAIC in Sun Yat-sen University Cancer Center were retrospectively analyzed. Among them，104 patients were male and 56 female， aged from 23 to 76 years， with a median age of 53 years. PHLP was diagnosed and graded according to the diagnostic criteria of the International Study Group of Liver Surgery （ISGLS）. Receiver operating characteristic （ROC） curve was delineated to evaluate the predictive efficiency of ICGR15 and ALBI score for PHLF. The independent risk factors of PHLF were analyzed by Logistic regression model. Overall survival （OS） and recurrence-free survival （RFS）were analyzed by Kaplan-Meier method and Log-rank test.

Results

Among 160 patients， 39（24.4%）cases developed PHLF， including 9（6.9%） cases of ＞grade B. The area under the ROC curve （AUC） of predictive value of preoperative ICGR15 and ALBI score for PHLF was 0.715 （95%CI: 0.626-0.805）and 0.704 （95%CI: 0.606-0.802）， the optimal thresholds were 0.060 and -2.73， the sensitivity was 0.795 and 0.615， and the specificity was 0.620 and 0.706， respectively. The AUC of predictive value of preoperative ICGR15 and ALBI score for ＞grade B PHLF was 0.798 （95%CI: 0.652-0.953） and 0.768 （95%CI: 0.617-0.920）， and the optimal thresholds were 0.128 and -2.50， the sensitivity was 0.727 and 0.636， and the specificity was 0.872 and 0.891， respectively. Multivariate Logistic regression analysis showed that preoperative international normalized ratio （INR） of ＞1 and ICGR15 of ＞0.060 were the independent risk factors for PHLF （OR=4.82， 6.15， both P＜0.05）. Preoperative ICGR15＞0.128 and age≤60 years old were independent influencing factors for ＞grade B PHLF （OR=6.65， 0.13， both P＜0.05）. All patients were divided into two groups when the threshold of ICGR15 was set as 0.060， and all patients in two groups did not obtain the median OS， with no statistical significance （χ²=0.705， P=0.40）. The median RFS was 22.0 and 20.8 months in two groups， and the difference was not statistically significant （χ²=0.725， P=0.39）.

Conclusions

Preoperative ICGR15 is an independent risk factor for PHLF in HCC patients after HAIC.ICGR15 and ALBI score yield equivalent predictive value for PHLF. HCC patients with preoperative ICGR15 of ＞0.128 or age ＞60 years old are more prone to ＞grade B PHLF.

Key words: Indocyanine green clearance test, Albumin-bilirubin (ALBI)score, Carcinoma,hepatocellular, Hepatic arterial infusion chemotherapy, Post-hepatectomy liver failure, Survival prognosis