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Pereyra D, Mandorfer M, Santol J, Gregory L, Koeditz C, Ortmayr G, Schuetz C, Rumpf B, Ammon D, Laengle J, Schwarz C, Jonas JP, Pinter M, Lindenlaub F, Tamandl D, Thiels C, Warner S, Smoot R, Truty M, Kendrick M, Nagorney D, Cleary S, Gruenberger T, Reiberger T, Starlinger P. Von Willebrand Factor Antigen Improves Risk Stratification for Patients with a Diagnosis of Resectable Hepatocellular Carcinoma. Ann Surg Oncol 2024:10.1245/s10434-024-15618-w. [PMID: 38896229 DOI: 10.1245/s10434-024-15618-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 05/21/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Posthepatectomy liver failure (PHLF), complications of portal hypertension, and disease recurrence determine the outcome for hepatocellular carcinoma (HCC) patients undergoing liver resection. This study aimed to evaluate the von Willebrand factor antigen (vWF-Ag) as a non-invasive test for clinically significant portal hypertension (CSPH) and a predictive biomarker for time to recurrence (TTR) and overall survival (OS). METHODS The study recruited 72 HCC patients with detailed preoperative workup from a prospective trial (NCT02118545) and followed for complications, TTR, and OS. Additionally, 163 compensated patients with resectable HCC were recruited to evaluate vWF-Ag cutoffs for ruling out or ruling in CSPH. Finally, vWF-Ag cutoffs were prospectively evaluated in an external validation cohort of 34 HCC patients undergoing liver resection. RESULTS In receiver operating characteristic (ROC) analyses, vWF-Ag (area under the curve [AUC], 0.828) was similarly predictive of PHLF as indocyanine green clearance (disappearance rate: AUC, 0.880; retention rate: AUC, 0.894), whereas computation of future liver remnant was inferior (AUC, 0.756). Cox-regression showed an association of vWF-Ag with TTR (per 10%: hazard ratio [HR], 1.056; 95% confidence interval [CI] 1.017-1.097) and OS (per 10%: HR, 1.067; 95% CI 1.022-1.113). In the analyses, VWF-Ag yielded an AUC of 0.824 for diagnosing CSPH, with a vWF-Ag of 182% or lower ruling out and higher than 291% ruling in CSPH. Therefore, a highest-risk group (> 291%, 9.7% of patients) with a 57.1% incidence of PHLF was identified, whereas no patient with a vWF-Ag of 182% or lower (52.7%) experienced PHLF. The predictive value of vWF-Ag for PHLF and OS was externally validated. CONCLUSION For patients with resectable HCC, VWF-Ag allows for simplified preoperative risk stratification. Patients with vWF-Ag levels higher than 291% might be considered for alternative treatments, whereas vWF-Ag levels of 182% or lower identify patients best suited for surgery.
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Affiliation(s)
- David Pereyra
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, General Hospital, Vienna, Austria
| | - Mattias Mandorfer
- Department of Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, General Hospital, Vienna, Austria
- Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, General Hospital, Vienna, Austria
| | - Jonas Santol
- Department of Surgery, HPB Center Vienna Health Network and Sigmund Freud Private University, Vienna, Austria
- Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Lindsey Gregory
- Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Christoph Koeditz
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, General Hospital, Vienna, Austria
| | - Gregor Ortmayr
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, General Hospital, Vienna, Austria
| | - Clara Schuetz
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, General Hospital, Vienna, Austria
| | - Benedikt Rumpf
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, General Hospital, Vienna, Austria
| | - Daphni Ammon
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, General Hospital, Vienna, Austria
| | - Johannes Laengle
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, General Hospital, Vienna, Austria
| | - Christoph Schwarz
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, General Hospital, Vienna, Austria
| | - Jan Philipp Jonas
- Department of Surgery, HPB Center Vienna Health Network and Sigmund Freud Private University, Vienna, Austria
| | - Matthias Pinter
- Department of Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, General Hospital, Vienna, Austria
| | - Florian Lindenlaub
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, General Hospital, Vienna, Austria
| | - Dietmar Tamandl
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, General Hospital, Vienna, Austria
| | - Cornelius Thiels
- Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Susanne Warner
- Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Rory Smoot
- Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Mark Truty
- Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Michael Kendrick
- Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, Rochester, MN, USA
| | - David Nagorney
- Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Sean Cleary
- Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Thomas Gruenberger
- Department of Surgery, HPB Center Vienna Health Network and Sigmund Freud Private University, Vienna, Austria
| | - Thomas Reiberger
- Department of Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, General Hospital, Vienna, Austria
- Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, General Hospital, Vienna, Austria
- Christian-Doppler Laboratory for Portal Hypertension and Liver Fibrosis, Medical University of Vienna, Vienna, Austria
| | - Patrick Starlinger
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, General Hospital, Vienna, Austria.
- Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, Rochester, MN, USA.
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Ursu CP, Ciocan A, Ursu Ș, Ciocan RA, Gherman CD, Cordoș AA, Vălean D, Pop RS, Furcea LE, Procopeț B, Ștefănescu H, Moiș EI, Al Hajjar N, Graur F. Prognostic Indicators of Overall Survival in Hepatocellular Carcinoma Patients Undergoing Liver Resection. Cancers (Basel) 2024; 16:1427. [PMID: 38611104 PMCID: PMC11010842 DOI: 10.3390/cancers16071427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 03/27/2024] [Accepted: 04/05/2024] [Indexed: 04/14/2024] Open
Abstract
Hepatocellular carcinoma (HCC) is the predominant form of primary liver cancer and the third contributor to malignancy-related deaths worldwide. The hepatic venous pressure gradient (HVPG), transient elastography-liver stiffness measurement (TE-LSM), and the association between TBS (tumor burden score), alpha-fetoprotein levels, and the Child-Pugh classification (TAC score) can serve as valuable prognostic indicators for these patients. Therefore, the main objective of our research was to analyze the prognostic value of the HVPG, TE-LSM, TBS, and TAC scores. An observational and survival study was conducted on 144 subjects. Our findings indicated that HVPG greater than 10 mmHg, AFP surpassing 400 ng/mL, an advanced C-P class, and low TAC score are independent predictors of overall survival. During the multivariate analysis, AFP serum levels and C-P class proved statistically significant. The present study revealed significant differences in overall survival between the two groups divided upon HVPG values and settled by the cutoff of 10 mmHg (p = 0.02). Moreover, by dividing the cohort into three groups based on the TAC score (very low, low, and moderate), statistically significant differences in overall survival were observed across the groups (p = 0.004).
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Affiliation(s)
- Cristina-Paula Ursu
- Department of Surgery, “Iuliu Hațieganu” University of Medicine and Pharmacy, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania; (C.-P.U.); (Ș.U.); (D.V.); (L.E.F.); (E.I.M.); (N.A.H.); (F.G.)
- “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania; (B.P.)
| | - Andra Ciocan
- Department of Surgery, “Iuliu Hațieganu” University of Medicine and Pharmacy, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania; (C.-P.U.); (Ș.U.); (D.V.); (L.E.F.); (E.I.M.); (N.A.H.); (F.G.)
- “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania; (B.P.)
| | - Ștefan Ursu
- Department of Surgery, “Iuliu Hațieganu” University of Medicine and Pharmacy, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania; (C.-P.U.); (Ș.U.); (D.V.); (L.E.F.); (E.I.M.); (N.A.H.); (F.G.)
- “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania; (B.P.)
| | - Răzvan Alexandru Ciocan
- Department of Surgery-Practical Abilities, “Iuliu Hațieganu” University of Medicine and Pharmacy, Marinescu Street, No. 23, 400337 Cluj-Napoca, Romania; (R.A.C.); (C.D.G.); (A.-A.C.)
| | - Claudia Diana Gherman
- Department of Surgery-Practical Abilities, “Iuliu Hațieganu” University of Medicine and Pharmacy, Marinescu Street, No. 23, 400337 Cluj-Napoca, Romania; (R.A.C.); (C.D.G.); (A.-A.C.)
| | - Ariana-Anamaria Cordoș
- Department of Surgery-Practical Abilities, “Iuliu Hațieganu” University of Medicine and Pharmacy, Marinescu Street, No. 23, 400337 Cluj-Napoca, Romania; (R.A.C.); (C.D.G.); (A.-A.C.)
- Romanian Society of Medical Informatics, 300041 Timișoara, Romania
| | - Dan Vălean
- Department of Surgery, “Iuliu Hațieganu” University of Medicine and Pharmacy, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania; (C.-P.U.); (Ș.U.); (D.V.); (L.E.F.); (E.I.M.); (N.A.H.); (F.G.)
- “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania; (B.P.)
| | - Rodica Sorina Pop
- Department of Community Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, Avram Iancu Street, No. 31, 400347 Cluj-Napoca, Romania;
| | - Luminița Elena Furcea
- Department of Surgery, “Iuliu Hațieganu” University of Medicine and Pharmacy, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania; (C.-P.U.); (Ș.U.); (D.V.); (L.E.F.); (E.I.M.); (N.A.H.); (F.G.)
- “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania; (B.P.)
| | - Bogdan Procopeț
- “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania; (B.P.)
- Department of Internal Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania
| | - Horia Ștefănescu
- “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania; (B.P.)
| | - Emil Ioan Moiș
- Department of Surgery, “Iuliu Hațieganu” University of Medicine and Pharmacy, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania; (C.-P.U.); (Ș.U.); (D.V.); (L.E.F.); (E.I.M.); (N.A.H.); (F.G.)
- “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania; (B.P.)
| | - Nadim Al Hajjar
- Department of Surgery, “Iuliu Hațieganu” University of Medicine and Pharmacy, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania; (C.-P.U.); (Ș.U.); (D.V.); (L.E.F.); (E.I.M.); (N.A.H.); (F.G.)
- “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania; (B.P.)
| | - Florin Graur
- Department of Surgery, “Iuliu Hațieganu” University of Medicine and Pharmacy, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania; (C.-P.U.); (Ș.U.); (D.V.); (L.E.F.); (E.I.M.); (N.A.H.); (F.G.)
- “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania; (B.P.)
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3
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Primavesi F, Maglione M, Cipriani F, Denecke T, Oberkofler CE, Starlinger P, Dasari BVM, Heil J, Sgarbura O, Søreide K, Diaz-Nieto R, Fondevila C, Frampton AE, Geisel D, Henninger B, Hessheimer AJ, Lesurtel M, Mole D, Öllinger R, Olthof P, Reiberger T, Schnitzbauer AA, Schwarz C, Sparrelid E, Stockmann M, Truant S, Aldrighetti L, Braunwarth E, D’Hondt M, DeOliveira ML, Erdmann J, Fuks D, Gruenberger T, Kaczirek K, Malik H, Öfner D, Rahbari NN, Göbel G, Siriwardena AK, Stättner S. E-AHPBA-ESSO-ESSR Innsbruck consensus guidelines for preoperative liver function assessment before hepatectomy. Br J Surg 2023; 110:1331-1347. [PMID: 37572099 PMCID: PMC10480040 DOI: 10.1093/bjs/znad233] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/09/2023] [Accepted: 07/04/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND Posthepatectomy liver failure (PHLF) contributes significantly to morbidity and mortality after liver surgery. Standardized assessment of preoperative liver function is crucial to identify patients at risk. These European consensus guidelines provide guidance for preoperative patient assessment. METHODS A modified Delphi approach was used to achieve consensus. The expert panel consisted of hepatobiliary surgeons, radiologists, nuclear medicine specialists, and hepatologists. The guideline process was supervised by a methodologist and reviewed by a patient representative. A systematic literature search was performed in PubMed/MEDLINE, the Cochrane library, and the WHO International Clinical Trials Registry. Evidence assessment and statement development followed Scottish Intercollegiate Guidelines Network methodology. RESULTS Based on 271 publications covering 4 key areas, 21 statements (at least 85 per cent agreement) were produced (median level of evidence 2- to 2+). Only a few systematic reviews (2++) and one RCT (1+) were identified. Preoperative liver function assessment should be considered before complex resections, and in patients with suspected or known underlying liver disease, or chemotherapy-associated or drug-induced liver injury. Clinical assessment and blood-based scores reflecting liver function or portal hypertension (for example albumin/bilirubin, platelet count) aid in identifying risk of PHLF. Volumetry of the future liver remnant represents the foundation for assessment, and can be combined with indocyanine green clearance or LiMAx® according to local expertise and availability. Functional MRI and liver scintigraphy are alternatives, combining FLR volume and function in one examination. CONCLUSION These guidelines reflect established methods to assess preoperative liver function and PHLF risk, and have uncovered evidence gaps of interest for future research.
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Affiliation(s)
- Florian Primavesi
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
- Department of General, Visceral and Vascular Surgery, Centre for Hepatobiliary Surgery, Vöcklabruck, Austria
| | - Manuel Maglione
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Federica Cipriani
- Hepatobiliary Surgery Division, San Raffaele Scientific Institute, Milan, Italy
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, University Medical Centre Leipzig, Leipzig, Germany
| | - Christian E Oberkofler
- Swiss Hepatopancreatobiliary Transplant Centre, Department of Surgery, University Hospital Zürich, Zürich, Switzerland
- Vivévis AG—Visceral, Tumour and Robotic Surgery, Clinic Hirslanden Zürich, Zürich, Switzerland
| | - Patrick Starlinger
- Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Bobby V M Dasari
- Department of Hepatobiliary–pancreatic and Liver Transplantation Surgery, University of Birmingham, Birmingham, UK
| | - Jan Heil
- Department of General, Visceral, Transplant and Thoracic Surgery, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Olivia Sgarbura
- Department of Surgical Oncology, Cancer Institute of Montpellier, University of Montpellier, Montpellier, France
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier, Montpellier, France
| | - Kjetil Søreide
- Department of Gastrointestinal Surgery, Hepatopancreatobiliary Unit, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Rafael Diaz-Nieto
- Liver Surgery Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Constantino Fondevila
- General and Digestive Surgery Service, Hospital Universitario La Paz, IdiPAZ, CIBERehd, Madrid, Spain
| | - Adam E Frampton
- Hepatopancreatobiliary Surgical Unit, Royal Surrey NHS Foundation Trust, Guildford, UK
- Section of Oncology, Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Dominik Geisel
- Department of Radiology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Benjamin Henninger
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Amelia J Hessheimer
- General and Digestive Surgery Service, Hospital Universitario La Paz, IdiPAZ, CIBERehd, Madrid, Spain
| | - Mickaël Lesurtel
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris Cité, Clichy, France
| | - Damian Mole
- Hepatopancreatobiliary Surgery Unit, Department of Clinical Surgery, University of Edinburgh, Edinburgh, UK
| | - Robert Öllinger
- Department of Surgery, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Pim Olthof
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
- Department of Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, the Netherlands
| | - Thomas Reiberger
- Division of Gastroenterology and Hepatology, Department of Medicine III and CD-Lab for Portal Hypertension and Liver Fibrosis, Medical University of Vienna, Vienna, Austria
| | - Andreas A Schnitzbauer
- Department of General, Visceral, Transplant and Thoracic Surgery, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Christoph Schwarz
- Department of General Surgery, Division of Visceral Surgery, Medical University Vienna, Vienna, Austria
| | - Ernesto Sparrelid
- Department of Clinical Science, Intervention and Technology, Division of Surgery and Oncology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Martin Stockmann
- Department of Surgery, Charité–Universitätsmedizin Berlin, Berlin, Germany
- Department of General, Visceral and Vascular Surgery, Evangelisches Krankenhaus Paul Gerhardt Stift, Lutherstadt Wittenberg, Germany
| | - Stéphanie Truant
- Department of Digestive Surgery and Transplantation, CHU Lille, Lille University, Lille, France
- CANTHER Laboratory ‘Cancer Heterogeneity, Plasticity and Resistance to Therapies’ UMR-S1277, Team ‘Mucins, Cancer and Drug Resistance’, Lille, France
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, San Raffaele Scientific Institute, Milan, Italy
| | - Eva Braunwarth
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Mathieu D’Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital Kortrijk, Kortrijk, Belgium
| | - Michelle L DeOliveira
- Swiss Hepatopancreatobiliary Transplant Centre, Department of Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Joris Erdmann
- Department of Surgery, Amsterdam UMC, Cancer Centre Amsterdam, the Netherlands
| | - David Fuks
- Department of Digestive, Hepatobiliary and Endocrine Surgery, Assistance Publique-Hôpitaux de Paris Centre Hopital Cochin, Paris, France
| | - Thomas Gruenberger
- Department of Surgery, Clinic Favoriten, Hepatopancreatobiliary Centre, Health Network Vienna and Sigmund Freud Private University, Vienna, Austria
| | - Klaus Kaczirek
- Department of General Surgery, Division of Visceral Surgery, Medical University Vienna, Vienna, Austria
| | - Hassan Malik
- Liver Surgery Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Dietmar Öfner
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Nuh N Rahbari
- Department of Surgery, University Hospital Mannheim, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Georg Göbel
- Department of Medical Statistics, Informatics, and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Ajith K Siriwardena
- Regional Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, Manchester, UK
| | - Stefan Stättner
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
- Department of General, Visceral and Vascular Surgery, Centre for Hepatobiliary Surgery, Vöcklabruck, Austria
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Kumar A, Maruyama H, Arora A, Sharma P, Anikhindi SA, Bansal N, Kumar M, Ranjan P, Sachdeva M, Khare S. Diagnostic accuracy of transient elastography in diagnosing clinically significant portal hypertension in patients with chronic liver disease: a systematic review and meta-analysis. J Med Ultrason (2001) 2022; 49:333-346. [DOI: 10.1007/s10396-022-01239-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/31/2022] [Indexed: 10/16/2022]
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Cho HJ, Ahn YH, Sim MS, Eun JW, Kim SS, Kim BW, Huh J, Lee JH, Kim JK, Lee B, Cheong JY, Kim B. Risk Prediction Model Based on Magnetic Resonance Elastography-Assessed Liver Stiffness for Predicting Posthepatectomy Liver Failure in Patients with Hepatocellular Carcinoma. Gut Liver 2021; 16:277-289. [PMID: 34810297 PMCID: PMC8924801 DOI: 10.5009/gnl210130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/08/2021] [Accepted: 06/14/2021] [Indexed: 11/04/2022] Open
Abstract
Background/Aims Posthepatectomy liver failure (PHLF) is a major complication that increases mortality in patients with hepatocellular carcinoma after surgical resection. The aim of this retrospective study was to evaluate the utility of magnetic resonance elastography-assessed liver stiffness (MRE-LS) for the prediction of PHLF and to develop an MRE-LS-based risk prediction model. Methods A total of 160 hepatocellular carcinoma patients who underwent surgical resection with available preoperative MRE-LS data were enrolled. Clinical and laboratory parameters were collected from medical records. Logistic regression analyses were conducted to identify the risk factors for PHLF and develop a risk prediction model. Results PHLF was present in 24 patients (15%). In the multivariate logistic analysis, high MRE-LS (kPa; odds ratio [OR] 1.49, 95% confidence interval [CI] 1.12 to 1.98, p=0.006), low serum albumin (≤3.8 g/dL; OR 15.89, 95% CI 2.41 to 104.82, p=0.004), major hepatic resection (OR 4.16, 95% CI 1.40 to 12.38, p=0.014), higher albumin-bilirubin score (>-0.55; OR 3.72, 95% CI 1.15 to 12.04, p=0.028), and higher serum α-fetoprotein (>100 ng/mL; OR 3.53, 95% CI 1.20 to 10.40, p=0.022) were identified as independent risk factors for PHLF. A risk prediction model for PHLF was established using the multivariate logistic regression equation. The area under the receiver operating characteristic curve (AUC) of the risk prediction model was 0.877 for predicting PHLF and 0.923 for predicting grade B and C PHLF. In leave-one-out cross-validation, the risk model showed good performance, with AUCs of 0.807 for all-grade PHLF and 0. 871 for grade B and C PHLF. Conclusions Our novel MRE-LS-based risk model had excellent performance in predicting PHLF, especially grade B and C PHLF.
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Affiliation(s)
- Hyo Jung Cho
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea
| | - Young Hwan Ahn
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea
| | - Min Suh Sim
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea
| | - Jung Woo Eun
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea
| | - Soon Sun Kim
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea
| | - Bong Wan Kim
- Department of Liver Transplantation and Hepatobiliary Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Jimi Huh
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Jei Hee Lee
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Jai Keun Kim
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Buil Lee
- Insight Mining Corporation, Daejeon, Korea
| | - Jae Youn Cheong
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Bohyun Kim
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea.,Department of Radiology, Seoul St. Mary's Hospital, Seoul, Korea
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6
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Zhao H, Zhang L, Chen H. Liver stiffness measured by magnetic resonance elastography in early recurrence of hepatocellular carcinoma after treatment: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2021; 100:e26183. [PMID: 34115001 PMCID: PMC8202664 DOI: 10.1097/md.0000000000026183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 05/16/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND With high diagnostic accuracy, magnetic resonance elastography (MRE) is a noninvasive tool and can be adopted to measure liver stiffness (LS). In this study, meta-analysis was carried out to further evaluate whether LS measured by MRE can predict early recurrence in patients with hepatocellular carcinoma (HCC). METHODS PUBMED, EMBASE, Web of Science, China National Knowledge Infrastructure, and Cochrane Library database were searched for studies related to LS measured by MRE in the prediction of recurrence in patients with HCC. Survival outcome was estimated by hazard ratios and 95% confidence intervals. Meta-analysis was conducted with the Stata 16.0. RESULTS The results of this meta-analysis will be submitted to a peer-reviewed journal for publication. CONCLUSION This study will provide evidence support for LS measured by MRE in predicting the recurrence of HCC. ETHICS AND DISSEMINATION The private information from individuals will not be published. This systematic review also should not damage participants' rights. Ethical approval is not available. The results may be published in a peer-reviewed journal or disseminated in relevant conferences. OSF REGISTRATION NUMBER DOI 10.17605/ OSF.IO / SURH3.
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Mocan T, Nenu I, Crăciun R, Spârchez Z. Treatment of hepatitis C virus infection in patients with hepatocellular carcinoma: Truth or dare? J Gastroenterol Hepatol 2021; 36:1518-1528. [PMID: 33326142 DOI: 10.1111/jgh.15376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/08/2020] [Accepted: 12/03/2020] [Indexed: 12/20/2022]
Abstract
The discovery of direct acting antivirals (DAA) with high rates of sustained virusological response is the biggest epoch-making event in the history of hepatitis C virus (HCV) treatment. DAAs improve liver function, prevent hepatic decompensation, and might even reverse liver fibrosis. Although initial research pointed towards a potential drawback, it is now known beyond doubt that DAA treatment reduces hepatocellular carcinoma (HCC) occurrence or recurrence after curative treatments. Unfortunately, the story has reached another plot twist, as several other issues have emerged: (i) Should we treat patients with early HCC and HCV before or after surgery/ablation? (ii) Should patients with HCC on the waiting list receive DAA before or after liver transplantation? (iii) Should we use interferon-free in patients with intermediate stage HCC or in patients under systemic treatments? In this review, we aim to offer some evidence-based answers to these changing clinical dilemmas where possible, or at least some educated guesses in cases were no or little data exists.
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Affiliation(s)
- Tudor Mocan
- 3rd Medical Department, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Institute for Gastroenterology and Hepatology "Prof. Dr. O. Fodor", Cluj-Napoca, Romania
| | - Iuliana Nenu
- 3rd Medical Department, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Institute for Gastroenterology and Hepatology "Prof. Dr. O. Fodor", Cluj-Napoca, Romania
| | - Rareș Crăciun
- 3rd Medical Department, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Institute for Gastroenterology and Hepatology "Prof. Dr. O. Fodor", Cluj-Napoca, Romania
| | - Zeno Spârchez
- 3rd Medical Department, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Institute for Gastroenterology and Hepatology "Prof. Dr. O. Fodor", Cluj-Napoca, Romania
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Ju BJ, Jin M, Tian Y, Zhen X, Kong DX, Wang WL, Yan S. Model for liver hardness using two-dimensional shear wave elastography, durometer, and preoperative biomarkers. World J Gastrointest Surg 2021; 13:127-140. [PMID: 33643533 PMCID: PMC7898182 DOI: 10.4240/wjgs.v13.i2.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/27/2020] [Accepted: 12/17/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Post-hepatectomy liver failure (PHLF) increases morbidity and mortality after liver resection for patients with advanced liver fibrosis and cirrhosis. Preoperative liver stiffness using two-dimensional shear wave elastography (2D-SWE) is widely used to evaluate the degree of fibrosis. However, the 2D-SWE results were not accurate. A durometer measures hardness by quantifying the ability of a material to locally resist the intrusion of hard objects into its surface. However, the durometer score can only be obtained during surgery.
AIM To measure correlations among 2D-SWE, palpation by surgeons, and durometer-measured objective liver hardness and to construct a liver hardness regression model.
METHODS We enrolled 74 hepatectomy patients with liver hardness in a derivation cohort. Tactile-based liver hardness scores (0-100) were determined through palpation of the liver tissue by surgeons. Additionally, liver hardness was measured using a durometer. Correlation coefficients for durometer-measured hardness and preoperative parameters were calculated. Multiple linear regression models were constructed to select the best predictive durometer scale. Receiver operating characteristic (ROC) curves and univariate and multivariate analyses were used to calculate the best model’s prediction of PHLF and risk factors for PHLF, respectively. A separate validation cohort (n = 162) was used to evaluate the model.
RESULTS The stiffness measured using 2D-SWE and palpation scale had good linear correlation with durometer-measured hardness (Pearson rank correlation coefficient 0.704 and 0.729, respectively, P < 0.001). The best model for the durometer scale (hardness scale model) was based on stiffness, hepatitis B virus surface antigen, and albumin level and had an R2 value of 0.580. The area under the ROC for the durometer and hardness scale for PHLF prediction were 0.807 (P = 0.002) and 0.785 (P = 0.005), respectively. The optimal cutoff value of the durometer and hardness scale was 27.38 (sensitivity = 0.900, specificity = 0.660) and 27.87 (sensitivity = 0.700, specificity = 0.787), respectively. Patients with a hardness scale score of > 27.87 were at a significantly higher risk of PHLF with hazard ratios of 7.835 (P = 0.015). The model’s PHLF predictive ability was confirmed in the validation cohort.
CONCLUSION Liver stiffness assessed by 2D-SWE and palpation correlated well with durometer hardness values. The multiple linear regression model predicted durometer hardness values and PHLF.
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Affiliation(s)
- Bing-Jie Ju
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou 310009, Zhejiang Province, China
- Research Center of Diagnosis and Treatment Technology for Hepatocellular Carcinoma of Zhejiang Province, Hangzhou 310009, Zhejiang Province, China
- Clinical Medicine Innovation Center of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Disease of Zhejiang University, Hangzhou 310009, Zhejiang Province, China
- Clinical Research Center of Hepatobiliary and Pancreatic Diseases of Zhejiang Province, Hangzhou 310009, Zhejiang Province, China
| | - Ming Jin
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou 310009, Zhejiang Province, China
- Research Center of Diagnosis and Treatment Technology for Hepatocellular Carcinoma of Zhejiang Province, Hangzhou 310009, Zhejiang Province, China
- Clinical Medicine Innovation Center of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Disease of Zhejiang University, Hangzhou 310009, Zhejiang Province, China
- Clinical Research Center of Hepatobiliary and Pancreatic Diseases of Zhejiang Province, Hangzhou 310009, Zhejiang Province, China
| | - Yang Tian
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou 310009, Zhejiang Province, China
- Research Center of Diagnosis and Treatment Technology for Hepatocellular Carcinoma of Zhejiang Province, Hangzhou 310009, Zhejiang Province, China
- Clinical Medicine Innovation Center of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Disease of Zhejiang University, Hangzhou 310009, Zhejiang Province, China
- Clinical Research Center of Hepatobiliary and Pancreatic Diseases of Zhejiang Province, Hangzhou 310009, Zhejiang Province, China
| | - Xiang Zhen
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou 310009, Zhejiang Province, China
- Research Center of Diagnosis and Treatment Technology for Hepatocellular Carcinoma of Zhejiang Province, Hangzhou 310009, Zhejiang Province, China
- Clinical Medicine Innovation Center of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Disease of Zhejiang University, Hangzhou 310009, Zhejiang Province, China
- Clinical Research Center of Hepatobiliary and Pancreatic Diseases of Zhejiang Province, Hangzhou 310009, Zhejiang Province, China
| | - De-Xing Kong
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
- School of Mathematical Sciences, Zhejiang University, Hangzhou 310027, Zhejiang Province, China
| | - Wei-Lin Wang
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou 310009, Zhejiang Province, China
- Research Center of Diagnosis and Treatment Technology for Hepatocellular Carcinoma of Zhejiang Province, Hangzhou 310009, Zhejiang Province, China
- Clinical Medicine Innovation Center of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Disease of Zhejiang University, Hangzhou 310009, Zhejiang Province, China
- Clinical Research Center of Hepatobiliary and Pancreatic Diseases of Zhejiang Province, Hangzhou 310009, Zhejiang Province, China
| | - Sheng Yan
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou 310009, Zhejiang Province, China
- Research Center of Diagnosis and Treatment Technology for Hepatocellular Carcinoma of Zhejiang Province, Hangzhou 310009, Zhejiang Province, China
- Clinical Medicine Innovation Center of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Disease of Zhejiang University, Hangzhou 310009, Zhejiang Province, China
- Clinical Research Center of Hepatobiliary and Pancreatic Diseases of Zhejiang Province, Hangzhou 310009, Zhejiang Province, China
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Mandorfer M, Hernández-Gea V, García-Pagán JC, Reiberger T. Noninvasive Diagnostics for Portal Hypertension: A Comprehensive Review. Semin Liver Dis 2020; 40:240-255. [PMID: 32557480 DOI: 10.1055/s-0040-1708806] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Noninvasive diagnostics for portal hypertension include imaging and functional tests, as well as blood-based biomarkers, and capture different features of the portal hypertensive syndrome. Definitive conclusions regarding their clinical utility require assessment of their diagnostic value in specific clinical settings (i.e., diagnosing a particular hemodynamic condition within a well-defined target population). Several noninvasive methods are predictive of clinically significant portal hypertension (CSPH; hepatic venous pressure gradient [HVPG] ≥ 10 mm Hg; the threshold for complications of portal hypertension); however, only a minority of them have been evaluated in compensated advanced chronic liver disease (i.e., the target population). Importantly, most methods correlate only weakly with HVPG at high values (i.e., in patients with CSPH). Nevertheless, selected methods show promise for diagnosing HVPG ≥ 16 mm Hg (the cut-off for increased risks of hepatic decompensation and mortality) and monitoring HVPG changes in response to nonselective beta-blockers or etiological treatments. Finally, we review established and potential future clinical applications of noninvasive methods.
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Affiliation(s)
- Mattias Mandorfer
- Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Barcelona Hepatic Hemodynamic Lab, Liver Unit, Hospital Clínic, Barcelona, Spain
| | - Virginia Hernández-Gea
- Barcelona Hepatic Hemodynamic Lab, Liver Unit, Hospital Clínic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Juan Carlos García-Pagán
- Barcelona Hepatic Hemodynamic Lab, Liver Unit, Hospital Clínic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Thomas Reiberger
- Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
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Fernández-Placencia R, Golse N, Cano L, Allard MA, Pittau G, Ciacio O, Cunha AS, Castaing D, Salloum C, Azoulay D, Cherqui D, Samuel D, Adam R, Vibert E. Spleen volumetry and liver transient elastography: Predictors of persistent posthepatectomy decompensation in patients with hepatocellular carcinoma. Surgery 2020; 168:17-24. [PMID: 32204923 DOI: 10.1016/j.surg.2020.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 01/27/2020] [Accepted: 02/05/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Posthepatectomy decompensation remains a frequent and poor outcome after hepatectomy, but its prediction is still inaccurate. Liver stiffness measurement can predict posthepatectomy decompensation, but there is a so-called "gray zone" that requires another predictor. Because splenomegaly is an objective sign of portal hypertension, we hypothesized that spleen volumetry could improve the identification of patients at risk. METHODS Patients with hepatocellular carcinoma who underwent hepatectomy in our tertiary center between August 2014 and December 2017 were reviewed. The primary endpoint was to determine if the spleen volumetry and liver stiffness measurement were independent predictors of posthepatectomy decompensation, and secondarily, to determine if they were synergistic through a theoretic predictive model. RESULTS One hundred and seven patients were included. The median follow-up time was 3 months (3-5). Postoperative 90-day mortality was 4.7%. By multivariate analysis, liver stiffness measurement and spleen volumetry predicted posthepatectomy decompensation. The liver stiffness measurement had a cutoff point of 11.6 kPa (area under receiver operating curve = 0.71 confidence interval 95% 0.71-0.88, sensitivity: 89%, specificity: 47%). The spleen volumetry cutoff point was 381.1 cm3 (area under receiver operating curve = 0.78, 95% confidence interval 0.77-0.93, sensitivity: 55%, specificity: 91%). The spleen volumetry improved prediction of posthepatectomy decompensation, because use of the spleen volumetry increased sensitivity (from 62% to 97%) and the negative predictive value (from 96% to 100%) along with a negligible decrease in specificity (from 96.7 to 93.4) and positive predictive value (from 64% to 59%) (P = .003). CONCLUSION Spleen volumetry (>380 cm3) and liver stiffness measurement (>12 kPa) are non-invasive, independent, and synergistic tools that appear to be able to predict posthepatectomy decompensation. The importance of this finding is that these measurements may help to anticipate posthepatectomy decompensation and may possibly be used to direct alternative treatments to resection.
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Affiliation(s)
- Ramiro Fernández-Placencia
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Centre Hépato-Biliaire, Villejuif, France; Department of Abdominal Surgery, Hepato-Pancreato-Biliary Section, Instituto Nacional de Enfermedades Neoplásicas (INEN) Lima, Peru
| | - Nicolas Golse
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Centre Hépato-Biliaire, Villejuif, France; Département Hospitalo-Universitaire Hepatinov, Villejuif, France; INSERM, Unit 1193, Villejuif, France; Univ Paris-Sud, UMR-S 1193, Villejuif, France
| | - Luis Cano
- INSERM, Unit 991, Univ Rennes, Centre Hospitalier Universitaire Rennes, INRA, Univ Bretagne Loire, Nutrition Metabolism and Cancer, Rennes, France
| | - Marc-Antoine Allard
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Centre Hépato-Biliaire, Villejuif, France; Département Hospitalo-Universitaire Hepatinov, Villejuif, France; INSERM, Unit 1193, Villejuif, France
| | - Gabriella Pittau
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Centre Hépato-Biliaire, Villejuif, France
| | - Oriana Ciacio
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Centre Hépato-Biliaire, Villejuif, France
| | - Antonio Sa Cunha
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Centre Hépato-Biliaire, Villejuif, France; Département Hospitalo-Universitaire Hepatinov, Villejuif, France; INSERM, Unit 1193, Villejuif, France
| | - Denis Castaing
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Centre Hépato-Biliaire, Villejuif, France; Département Hospitalo-Universitaire Hepatinov, Villejuif, France; INSERM, Unit 1193, Villejuif, France
| | - Chady Salloum
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Centre Hépato-Biliaire, Villejuif, France
| | - Daniel Azoulay
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Centre Hépato-Biliaire, Villejuif, France; Department of Hepatobiliary and Pancreatic Surgery and Transplantation, Sheba Medical Center, Faculty of Medicine Tel Aviv University, Israel
| | - Daniel Cherqui
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Centre Hépato-Biliaire, Villejuif, France; Département Hospitalo-Universitaire Hepatinov, Villejuif, France; INSERM, Unit 1193, Villejuif, France
| | - Didier Samuel
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Centre Hépato-Biliaire, Villejuif, France; Département Hospitalo-Universitaire Hepatinov, Villejuif, France; INSERM, Unit 1193, Villejuif, France; Univ Paris-Sud, UMR-S 1193, Villejuif, France
| | - René Adam
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Centre Hépato-Biliaire, Villejuif, France; Département Hospitalo-Universitaire Hepatinov, Villejuif, France; INSERM, Unit 985, Villejuif, France; Univ Paris-Sud, UMR-S 985, Villejuif, France
| | - Eric Vibert
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Centre Hépato-Biliaire, Villejuif, France; Département Hospitalo-Universitaire Hepatinov, Villejuif, France; INSERM, Unit 1193, Villejuif, France; Univ Paris-Sud, UMR-S 1193, Villejuif, France.
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