Postoperative result prediction in patients with hepatocellular carcinoma

• Sergey E. Voskanyan
• Evgeny S. Chuchuev
• Vladimir S. Rudakov
• Popov M.V.
• Zamyatkin A.A.

Abstract

Background. Incidence of hepatocellular carcinoma is increasing worldwide. The main methods of treatment remain liver resection and transplantation. Treatment tactics depend on the prevalence of malignancy and liver function.

Aim. To assess the possibility of predicting the results of treatment by means of routine clinical and laboratory methods for determining liver function.

Material and methods. The analysis included 152 patients with hepatocellular carcinoma who underwent surgical treatment. Liver function was assessed at the preoperative stage according to the classifications: Child-Pugh, Child-Pugh + creatinine, MELD, De Ritis ratio, APRI (AST to platelet ratio index), FIB-4, HALT-C, MDA, GUCI tests. All complications and deaths were assessed in the postoperative period.

Results. A retrospective analysis was carried out. Statistically significant results were found in the classifications APRI (complications р=0.05, mortality р=0.01), Child-Pugh (complications р=0.004, mortality р=0.0001), and Child-Pugh + creatinine (complications р=0.008, mortality р=0.0001). However, only APRI has an average and good informative value in predicting postoperative complications of 0.62 and mortality of 0.74.

Conclusion. According to the results of our study, it is recommended to use the APRI. When the APRI increases >1, in order to plan a safe surgery, liver function should be assessed in addition by several methods. When liver failure is detected, liver transplantation is recommended. Further research is required to develop a detailed algorithm for preoperative examination of patients with liver cirrhosis.

Keywords:hepatocellular cancer, hepatocellular carcinoma, liver resection, liver transplantation, liver function

References 

1.    URL: http://www.unic.ru

2.    URL: https://www.who.int/ru

3.    Vibert E., Schwartz M., Kim M., et al. Advances in resection and transplantation for hepatocellular carcinoma. J Hepatol. 2020; 72: 262-76.  DOI: https://doi.org/10.1016/j.jhep.2019.11.017

4.    Allaire M., Goumard C., Lim C., LeCleach A., Wagner M, Scatton O. New frontiers in liver resection for hepatocellular carcinoma. J Hep Rep. 2020; 2 (4): 100134. DOI: https://doi.org/10.1016/jjhepr.2020.100134

5.    Heimbach J.K., Kulik L.M., Finn R.S., Sirlin C.B., Abecassis M.M., Roberts L.R., et al. AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology. 2018; 67 (1): 358-80. DOI: https://doi.org/10.1002/hep.29086

6.    Teh S.H., Christein J., Donohue J., Que F., Kendrick M., Farnell M., et al. Hepatic resection of hepatocellular carcinoma in patients with cirrhosis: model of end-stage live disease (MELD) score predicts perioperative mortality. J Gastrointest Surg. 2005; 9: 1207-15. DOI: https://doi.org/10.1016/j.gassur.2005.09.008

7.    Schwartz M., Roayaie S., Konstadoulakis M. Strategies for the management of hepatocellular carcinoma. Nat Clin Pract Oncol. 2007; 4 (7): 424-32. DOI: https://doi.org/10.1038/ncponc0844

8.    Harrod E., Moctezuma-Velazquez C., Gurakar A., Ala A., Dieterich D., Saberi D. Management of concomitant hepatocellular carcinoma and chronic hepatitis C. Hepatoma Res. 2019; 5: 28. DOI: https://doi.org/10.20517/2394-5079.2019.15

9.    Hasegawa K., Kokudo N., Imamura H., Matsuyama Y., Aoki T., Minagawa M., et al. Prognostic impact of anatomic resection for hepatocellular carcinoma. Ann Surg. 2005; 9: 242-52. DOI: https://doi.org/10.1097/01.sla.0000171307.37401.db

10.    Mahmud N. Selection for liver transplantation: indications and evaluation. Curr Hepatol Rep. 2020; 19: 1-10. DOI: https://doi.org/10.1007/s11901-020-00527-9

11. Lingiah V.A., Niazi M., Olivo R., Paterno F., Guarrera J.V., Pyrsopoulos N.T. Liver transplantation beyond Milan criteria. J Clin Transl Hepatol. 2020; 8 (1): 69-75. DOI: https://doi.org/10.14218/JCTH.2019.00050

12.    Samuel D., Colombo M., Serag H. What is ago al that transplantation should a chievein the contex to The patocellular carcinoma? In: Proceedings of the 2010 International Consensus Conference on Liver transplantation for HCC. Zurich, Switzerland, 2-4 December 2010: 12-9.

13.    Voskanyan S.E., Sushkov A.I., Artem’ev A.I., Za-bezhinsky D.A., Naydenov E.V., Bashkov A.N., et al. Salvage liver transplantation for hepatocellular carcinoma. Khirur-giya. Zhurnal imeni N.I. Pirogova. [Surgery. The Journal Named after N.I. Pirogov]. 2019; (10): 21-8. DOI: https://doi.org/10.17116/hirurgia201910121  (in Russian)

14.    Voskanyan S.E., Chuchuev E.S., Artem’ev A.I., Zabezhinsky D.A., Bashkov A.N., Zhurbin A.S., et al. Associated Liver Partition and Portal vein Ligation for Staged hepatectomy (ALPPS) in focal liver diseases management. Khirurgiya. Zhurnal imeni N.I. Pirogova. [Surgery. The Journal Named after N.I. Pirogov]. 2018; (2): 39-44. DOI: https://doi.org/10.17116/hirurgia2018239-44 (in Russian)

15. Mal’tseva A.P., Syutkin V.E., Kolyshev I.Yu, Ru-dakov V.S., Svetlakova D.S., Sadykhov Z.A., et al. Transplantation in oncology: the future of a multidisciplinary approach. Transplantologiya [Transplantology]. 2019; 11 (3): 218-33. DOI: https://doi.org/10.23873/2074-0506-2019-11-3-218-233  (in Russian)

16.    Voskanyan S.E., Artem’ev A.I., Sushkov A.I., Kolyshev I.Yu., Rudakov V.S., Shabalin M.V., et al. Vascular reconstruction and outcomes of 220 adult-to-adult right lobe living donor liver transplantations. Al’manakh klin-icheskoy meditsiny [Almanac of Clinical Medicine]. 2018; 46 (6): 598-608. (in Russian)

17.    EASL clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2018; 69: 182236.

18.    Capussotti L., Muratore A.,Amisano M., Polastri R., Bouzari H., Massucco P. Liver resection for hepatocellular carcinoma on cirrhosis: analysis of mortality, morbidity and survival - a European single center experience. Eur J Surg Oncol. 2005; 31: 986-93. DOI: https://doi.org/10.1016/j.ejso.2005.04.002

19.    Zhen N., Mahmud W.N. The imperative for an updated cirrhosis surgical risk score. Ann Hepatol. 2020; 19: 4341-3. DOI: https://doi.org/10.1016/j.ao-hep.2020.04.005

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