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Zuo D, Li Y, Liu H, Liu D, Fang Q, Li P, Tu L, Xiong Y, Zeng Y, Liu P. Value of Non-tumoral Liver Volume in the Prognosis of Large Hepatocellular Carcinoma Patients After R0 Resection. J Clin Transl Hepatol 2023; 11:560-571. [PMID: 36969888 PMCID: PMC10037504 DOI: 10.14218/jcth.2022.00170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/02/2022] [Accepted: 07/29/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND AND AIMS Hepatectomy is an effective treatment for selected patients with large hepatocellular carcinoma (HCC). This study aimed to develop a nomogram incorporating non-tumoral liver volume (non-TLV) and liver function markers to predict the patients' overall survival (OS) and disease-free survival (DFS). METHODS Data of 198 consecutive large HCC patients who underwent hepatectomy at the Zhongshan Hospital Xiamen University were collected. Another 68 patients from the Mengchao Hepatobiliary Surgery Hospital served as an external validation cohort. The nomograms were developed based on the independent prognostic factors screened by multivariate Cox regression analyses. Concordance index (C-index), calibration curves, and time-dependent receiver operating characteristic (ROC) curves were used to measure the discrimination and predictive accuracy of the models. RESULTS High HBV DNA level, low non-TLV/ICG, vascular invasion, and a poorly differentiated tumor were confirmed as independent risk factors for both OS and DFS. The model established in this study predicted 5-year post-operative survival and DFS in good agreement with the actual observation confirmed by the calibration curves. The C-indexes of the nomograms in predicting OS and DFS were 0.812 and 0.823 in the training cohort, 0.821 and 0.846 in the internal validation cohort, and 0.724 and 0.755 in the external validation cohort. The areas under the ROC curves (AUCs) of nomograms for predicted OS and DFS at 1, 3, and 5 year were 0.85, 0.86, 0.83 and 0.76, 0.76, 0.63, respectively. CONCLUSIONS Nomograms with non-TLV/ICG predicted the prognosis of single large HCC patients accurately and effectively.
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Affiliation(s)
- Dongliang Zuo
- Department of Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Yuntong Li
- Department of Hepatobiliary Surgery, Zhongshan Hospital Xiamen University, Xiamen, Fujian, China
| | - Hongzhi Liu
- Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Surgery Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Dongxu Liu
- Public Health Clinical Center of Chengdu, Chengdu, Sichuan, China
| | - Qinliang Fang
- Department of Hepatobiliary Surgery, Zhongshan Hospital Xiamen University, Xiamen, Fujian, China
| | - Pengtao Li
- Department of Hepatobiliary Surgery, Zhongshan Hospital Xiamen University, Xiamen, Fujian, China
| | - Liang Tu
- Department of Hepatobiliary Surgery, Zhongshan Hospital Xiamen University, Xiamen, Fujian, China
| | - Yu Xiong
- Department of Hepatobiliary Surgery, Zhongshan Hospital Xiamen University, Xiamen, Fujian, China
| | - Yongyi Zeng
- Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Surgery Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Correspondence to: Pingguo Liu, Department of Hepatobiliary Surgery, Zhongshan Hospital Xiamen University, 201 Hubin South Rd., Xiamen, Fujian 361001, China. Tel/Fax: +86-592-2993141, E-mail: ; Yongyi Zeng, Mengchao Hepatobiliary Hospital of Fujian Medical University, Xihong Road 312, Fuzhou, Fujian 350025, China. Tel/Fax: +86-591-8370-5927, E-mail:
| | - Pingguo Liu
- Department of Hepatobiliary Surgery, Zhongshan Hospital Xiamen University, Xiamen, Fujian, China
- Correspondence to: Pingguo Liu, Department of Hepatobiliary Surgery, Zhongshan Hospital Xiamen University, 201 Hubin South Rd., Xiamen, Fujian 361001, China. Tel/Fax: +86-592-2993141, E-mail: ; Yongyi Zeng, Mengchao Hepatobiliary Hospital of Fujian Medical University, Xihong Road 312, Fuzhou, Fujian 350025, China. Tel/Fax: +86-591-8370-5927, E-mail:
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Araki K, Shibuya K, Harimoto N, Watanabe A, Tsukagoshi M, Ishii N, Ikota H, Yokobori T, Tsushima Y, Shirabe K. A prospective study of sequential hepatic vein embolization after portal vein embolization in patients scheduled for right-sided major hepatectomy: Results of feasibility and surgical strategy using functional liver assessment. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2023; 30:91-101. [PMID: 35737808 DOI: 10.1002/jhbp.1207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 05/25/2022] [Accepted: 06/01/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Hepatic vein embolization (HVE) added to portal vein embolization (PVE) can further increase future remnant liver volume (FRLV) compared with PVE alone. This study was aimed to evaluate feasibility of sequential HVE in a prospective trial and to verify surgical strategy using functional FRLV (fFRLV). METHODS Hepatic vein embolization was prospectively indicated for post-PVE patients scheduled for right-sided major hepatectomy if the resection limit of fFRLV using EOB-magnetic resonance imaging was not satisfied. The resection limit was fFRLV: 615 mL/m2 for predicting post-hepatectomy liver failure. Patients who underwent sequential PVE-HVE (n = 12) were compared with those who underwent PVE alone (n = 31). RESULTS All patients underwent HVE with no severe complications. Median fFRLV increased from 396 (range: 251-581) to 634 (range: 422-740) mL/m2 by sequential PVE-HVE. From PVE to HVE, both of FRLV (P < .001) and fFRLV (P = .005) significantly increased. The increased width of fFRLV was larger than that of FRLV after performing HVE. Median growth rate was 71.3 (range: 33.3-80.3) %, which was higher than that of PVE alone (27.0%, range: 6.0-78.0). All-cohort resection rate was 88.3%. Strategy of using fFRLV for the resection limit and performing HVE in patients with insufficient functional volume resulted in no liver failure in all patients who underwent hepatectomy. CONCLUSIONS Sequential HVE after PVE is feasible and safe, and HVE induced possibility of further liver growth and its functional improvement. Our surgical strategy using fFRLV may be justified.
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Affiliation(s)
- Kenichiro Araki
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Kei Shibuya
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.,Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Norifumi Harimoto
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Akira Watanabe
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Mariko Tsukagoshi
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Norihiro Ishii
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hayato Ikota
- Clinical Department of Pathology, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Takehiko Yokobori
- Division of Integrated Oncology Research, Gunma University Initiative for Advanced Research (GIAR), Maebashi, Gunma, Japan
| | - Yoshito Tsushima
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Ken Shirabe
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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