Volumetric assessment and clinical predictors of cirrhosis in patients undergoing hepatectomy for hepatocellular carcinoma with presumed normal liver function,Hepatology International

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Volumetric assessment and clinical predictors of cirrhosis in patients undergoing hepatectomy for hepatocellular carcinoma with presumed normal liver function
Hepatology International ( IF 5.9 ) Pub Date : 2021-08-23 , DOI: 10.1007/s12072-021-10246-y
Takayuki Shimizu ₁ , Taku Aoki ₁ , Kyung-Hwa Park ₁ , Takatsugu Matsumoto ₁ , Takayuki Shiraki ₁ , Yuhki Sakuraoka ₁ , Shozo Mori ₁ , Yukihiro Iso ₁ , Mitsuru Ishizuka ₁ , Keiichi Kubota ₁

Affiliation

Aim

Indocyanine green retention rate at 15 min (ICGR15) is a frequently used indicator of liver function. Herein, clinicopathological characteristics of cirrhotic patients with normal ICGR15 value (< 10%) were investigated, as these patients have risk of postoperative liver insufficiency when receiving a major hepatic resection.

Methods

Patients undergoing hepatectomy for hepatocellular carcinoma were divided into three groups: non-cirrhotic livers (Group A, n = 112): cirrhotic livers with ICGR15 < 10% (Group B, n = 71): and cirrhotic livers with ICGR15 > 10% (Group C, n = 296). Background characteristics and surgical outcomes were compared between groups. Functional liver volume (FLV) was computed using total liver volume and signal intensity ratio. Liver parenchymal cell volume ratio was measured in non-cancerous tissue obtained from resected specimens. Univariate and multivariate analyses were performed to detect clinical characteristics correlating with cirrhotic liver pathology with normal ICGR15.

Results

There was no significant difference between groups in TLV. FLV was gradually reduced from Group A toward Group C. Liver parenchymal cell volume ratio was also gradually reduced from Group A toward Group C. Multivariate analysis revealed that platelet count (< 12 × 10⁴/mm³) (p = 0.001) and prothrombin time (< 80%) (p = 0.025) were significantly associated with cirrhotic liver pathology among patients with normal ICGR15.

Conclusion

Our results suggested that cirrhotic liver pathology despite normal liver function was characterized by slightly decreasing liver parenchyma as well as slight degree of fibrosis. Platelet count and PT% are useful for predicting liver cirrhosis with normal ICGR15.

Graphic abstract

中文翻译：

假定肝功能正常的肝细胞癌患者接受肝切除术的体积评估和肝硬化的临床预测因素

目的

吲哚菁绿 15 分钟保留率 (ICGR15) 是常用的肝功能指标。在此，研究了 ICGR15 值正常（<10%）的肝硬化患者的临床病理特征，因为这些患者在接受主要肝切除术时有术后肝功能不全的风险。

方法

因肝细胞癌行肝切除术的患者分为三组：非肝硬化（A组，n =112）：ICGR15<10%的肝硬化（B组，n =71）；ICGR15>10%的肝硬化（ C 组，n = 296）。比较了组间的背景特征和手术结果。使用总肝脏体积和信号强度比计算功能性肝脏体积 (FLV)。在从切除标本中获得的非癌组织中测量肝实质细胞体积比。进行单变量和多变量分析以检测与正常 ICGR15 的肝硬化病理相关的临床特征。

结果

TLV 组间无显着差异。FLV 从 A 组向 C 组逐渐减少。肝实质细胞体积比也从 A 组向 C 组逐渐减少。多变量分析显示血小板计数 (< 12 × 10 ⁴ /mm ³ ) ( p = 0.001) 和凝血酶原在 ICGR15 正常的患者中，时间 (< 80%) ( p = 0.025) 与肝硬化病理显着相关。