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Nomogram for individualised prediction of liver failure risk after hepatectomy in patients with resectable hepatocellular carcinoma: the evidence from ultrasound data

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Abstract

Objectives

This study sought to develop a clinical nomogram for predicting post-hepatectomy liver failure (PHLF) among patients with resectable hepatocellular carcinoma (HCC).

Methods

The nomogram was established based on data obtained from a prospective study on 136 consecutive patients with resectable HCC undergoing hepatectomy from January 2015 to December 2015 in our centre. Another 80 patients in our centre served as an independent internal validation set. The predictive accuracy and discriminative ability of the nomogram were determined by concordance index (C-index), calibration curve and compared with commonly predictive systems.

Results

PHLF occurred in 30.9% of patients in the derivation set, including 36 and six patients with Grades A and B, respectively. The statistical nomogram built on the basis of platelet count, serum bilirubin, serum GGT, clinical signs of portal hypertension and shear wave elastography had good calibration and discriminatory abilities, with C-indices of 0.85. These models showed satisfactory goodness-of-fit and discrimination abilities in the independent validation set with C-indices of 0.824 for PHLF. The areas under the receiver-operator characteristic (ROC) curve using our methods were greater than those of conventional predictive systems in the validation patients (corresponding C-indices, 0.572–0.701).

Conclusions

This novel nomogram provides good preoperative prediction of PHLF in patients with resectable HCC.

Key Points

• The nomogram was built by platelet count, bilirubin, GGT, CSPH and SWE.

• The nomogram showed good calibration and discriminatory abilities in the different sets.

• Compared with other models, the nomogram indicated better discriminatory capability.

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Abbreviations

CSPH:

Clinical signs of portal hypertension

EASL:

European Association for the Study of the Liver

ECOG:

Eastern Cooperative Oncology Group

HCC:

Hepatocellular carcinoma

ISGLS:

International Study Group of Liver Surgery

LS:

Liver stiffness

MELD:

Model for End-Stage Liver Disease

PHLF:

Post-hepatectomy liver failure

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Acknowledgments

The scientific guarantor of this publication is Professor Hong Han and Professor Wenping Wang. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has received following funding: Youth Foundation of Zhongshan Hospital Fudan University (2016ZSQN36); Health and Family Planning Commission Foundation of Shanghai (20134085); National Natural Science Foundation of China (81371577) (81571675).

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Authors and Affiliations

  1. Department of Ultrasound, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China

    Hao Hu, Hong Han, Wen Ping Wang & Hong Ding

  2. Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China

    Hao Hu, Hong Han, Wen Ping Wang & Hong Ding

  3. State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Centre of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Xi Kun Han

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  1. Hao Hu
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  2. Hong Han
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  3. Xi Kun Han
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  4. Wen Ping Wang
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  5. Hong Ding
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Corresponding authors

Correspondence to Hong Han or Wen Ping Wang.

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Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Funding

The authors state that this work has not received any funding.

Statistics and biometry

One of the authors has significant statistical expertise.

Ethical approval

Institutional Review Board approval was obtained.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Methodology

A prospective, diagnostic or prognostic study, performed at one institution.

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Hu, H., Han, H., Han, X.K. et al. Nomogram for individualised prediction of liver failure risk after hepatectomy in patients with resectable hepatocellular carcinoma: the evidence from ultrasound data. Eur Radiol 28, 877–885 (2018). https://doi.org/10.1007/s00330-017-4900-2

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  • DOI: https://doi.org/10.1007/s00330-017-4900-2

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