Relevance of liver surface nodularity for preoperative risk assessment in patients with resectable hepatocellular carcinoma
Relevance of liver surface nodularity for preoperative risk assessment in patients with resectable hepatocellular carcinoma
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DOI：
10.1002/bjs.11511
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发表时间：
2020-03-02
影响因子：
9.6
通讯作者：
Soubrane, O.
中科院分区：
文献类型：
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作者：
Hobeika, C.;Cauchy, F.;Soubrane, O.
术前常规CT图像上肝表面结节(LSN)的定量可以检测出肝硬变和临床上有意义的门静脉高压症。本研究旨在评估LSN在可切除肝细胞癌术前风险评估中的意义。方法对2012-2017年间所有接受肝切除术的肝癌患者进行回顾性分析。在术前CT图像上评估左肝叶肝脂肪交界处的LSN。对LSN定量的可行性进行评估。结果210例患者中，LSN测量成功187例(89中心点0%)。其中，LSN得分的中位数为2中心点42(iq.r。2中心点21~2中心点66)和52中心点9%为重度纤维化，其中33中心点7%为肝硬变。LSN评分随肝静脉压力梯度(P=0中心点048)、脂肪变性严重程度(P=0中心点011)和肝纤维化分级(P=0中心点001)的增加而增加。LSN评分与严重并发症(优势比(OR)5中心点25；P=0中心点006)和PHLF(OR 6中心点78；P=0中心点003)独立相关。在匹配了终末期肝病模型、天冬氨酸转氨酶/血小板比率指数和纤维化-4评分后，LSN评分为2中心点63或更高的患者发生PHLF的风险增加(OR 5中心点81；P=0中心点018)。在无严重纤维化的患者亚组中，LSN对严重并发症的预测是准确的(P=0中心点005)。有(P=0中心点039)或无(P=0中心点018)严重纤维化且LSN评分增加的患者有更高的综合并发症指数评分。在临床上有显著门脉高压的肝硬变患者中，LSN值低于2中心点63排除了PHFL的风险。结论LSN测量是一种实用的工具，可以改善对肝癌患者的术前评估和管理。
Background Quantification of liver surface nodularity (LSN) on routine preoperative CT images allows detection of cirrhosis and clinically significant portal hypertension. This study aimed to assess the relevance of LSN in preoperative assessment of operative risks for patients with resectable hepatocellular carcinoma (HCC).Methods All patients undergoing hepatectomy for HCC between 2012 and 2017 were analysed retrospectively. LSN was assessed at the liver-fat interface on the left liver lobe on preoperative CT images. The feasibility of LSN quantification was assessed. The association between LSN and outcomes (severe complications and posthepatectomy liver failure (PHLF)) was evaluated by multivariable analysis and after propensity score matching.Results Among 210 patients, LSN measurement was successful in 187 (89 center dot 0 per cent). Among these, the median LSN score was 2 center dot 42 (i.q.r. 2 center dot 21-2 center dot 66) and 52 center dot 9 per cent had severe fibrosis, including 33 center dot 7 per cent with cirrhosis. LSN score increased with hepatic venous pressure gradient (P = 0 center dot 048), severity of steatosis (P = 0 center dot 011) and fibrosis grade (P = 0 center dot 001). LSN score was independently associated with severe complications (odds ratio (OR) 5 center dot 25; P = 0 center dot 006) and PHLF (OR 6 center dot 78; P = 0 center dot 003). After matching with respect to model for end-stage liver disease, aspartate aminotransferase-to-platelet ratio index and fibrosis-4 score, patients with a LSN score of 2 center dot 63 or higher retained an increased risk of PHLF (OR 5 center dot 81; P = 0 center dot 018). In the subgroup of patients without severe fibrosis, LSN was accurate in predicting severe complications (P = 0 center dot 005). Patients with (P = 0 center dot 039) or without (P = 0 center dot 018) severe fibrosis with increased LSN score had a higher comprehensive complication index score. Among patients with cirrhosis who had clinically significant portal hypertension, a LSN value below 2 center dot 63 ruled out the risk of PHLF.Conclusion LSN measurement represents a practical tool that may allow improvement in the preoperative evaluation and management of patients with HCC.