J Cancer 2021; 12(17):5260-5267. doi:10.7150/jca.58726 This issue

Research Paper

External Validation of Six Liver Functional Reserve Models to predict Posthepatectomy Liver Failure after Major Resection for Hepatocellular Carcinoma

Guangmeng Guo1, Zhengqing Lei, MD1, Xuewu Tang1, Weihu Ma1, Anfeng Si, MD2, Pinghua Yang, MD3, Qi Li, MD4, Zhimin Geng, MD4, Jiahua Zhou, MD, PhD1, Zhangjun Cheng, MD, FACS1✉

1. Hepato-pancreato-biliary center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.
2. Department of Surgical Oncology, Qin Huai Medical District of Eastern Theater General Hospital, Nanjing, China.
3. Department of Minimally Invasive Surgery, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
4. Department of Hepatobiliary Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.

This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/). See http://ivyspring.com/terms for full terms and conditions.
Guo G, Lei Z, Tang X, Ma W, Si A, Yang P, Li Q, Geng Z, Zhou J, Cheng Z. External Validation of Six Liver Functional Reserve Models to predict Posthepatectomy Liver Failure after Major Resection for Hepatocellular Carcinoma. J Cancer 2021; 12(17):5260-5267. doi:10.7150/jca.58726. Available from https://www.jcancer.org/v12p5260.htm

File import instruction


Graphic abstract

Objective: To validate and compare the predictive ability of albumin-bilirubin model (ALBI) with other 5 liver functional reserve models (APRI, FIB4, MELD, PALBI, King's score) for posthepatectomy liver failure (PHLF) in patients with hepatocellular carcinoma (HCC) who underwent major hepatectomy.

Methods: Data of patients undergoing major hepatectomy for HCC from 4 hospitals between January 01, 2008 and December 31, 2019 were retrospectively analyzed. PHLF was evaluated according to the definition of the 50-50 criteria. Performances of six liver functional reserve models were determined by the area under the receiver operating characteristic curve (AUC), calibration plot and decision curve analysis.

Results: A total of 745 patients with 103 (13.8%) experienced PHLF were finally included in this study. Among six liver functional reserve models, ALBI showed the highest AUC (0.64, 95% CI: 0.58-0.69) for PHLF. All models showed good calibration and greater net benefit than treating all patients at a limit range of threshold probabilities, but the ALBI demonstrated net benefit across the largest range of threshold probabilities. Subgroup analysis also showed ALBI had good predictive performance in cirrhotic (AUC=0.63) or non-cirrhotic (AUC=0.62) patients.

Conclusion: Among the six models, the ALBI model shows more accurate predictive ability for PHLF in HCC patients undergoing major hepatectomy, regardless of having cirrhosis or not.

Keywords: hepatocellular carcinoma, major hepatectomy, preoperative prediction, posthepatectomy liver failure