脾脏硬度和体积预测肝细胞癌患者肝切除术后发生肝功能衰竭的价值

Value of spleen stiffness and spleen volume in predicting posthepatectomy liver failure in patients with hepatocellular carcinoma

目的评估脾脏硬度(SS)和脾脏体积(SV)在肝细胞癌(HCC)患者接受肝切除术后肝功能衰竭(PHLF)中的预测价值。方法收集2014年5月-2019年2月于苏州市第九人民医院和第二军医大学第三附属医院接受肝切除术的HCC患者的临床数据。所有患者术前测量SS、肝脏硬度(LS)、SV、剩余残肝体积(FRLV)和炎症指标等。计量资料两组间比较采用独立样本t检验;采用Pearson相关性分析SS与LS、SV的相关性;用单因素和多因素logistic回归分析评价PHLF发生的影响因素。通过受试者工作特征曲线(ROC曲线)评估SS、SV/FRLV和入肝血流阻断(HIO)的临床价值,计算ROC曲线下面积(AUC)、敏感度和特异度。结果最终纳入148例HCC患者,其中21例(14.2%)发生PHLF。根据术后病理报告,73例(49.3%)患者发现肝硬化。肝硬化与非肝硬化患者比较,SV、LS、SS差异均有统计学意义(t值分别为13.610、6.952、20.580,P值均<0.001)。相关性分析结果显示,SS与LS、SV均呈正相关(r值分别为0.650、0.453,P值分别为0.002、0.005)。单因素logistic回归分析显示,肿瘤直径、肝硬化、中性粒细胞/淋巴细胞、LS、SS、SV/FRLV、手术时间、是否输血、HIO时间均与PHLF的发生有关(P值均<0.05);多因素logistic回归分析显示,SV/FRLV[风险比(HR)=26.564,95%可信区间(95%CI):1.611~422.541,P<0.001]、SS(HR=1.018,95%CI:1.014~1.154,P=0.008)和HIO时间(HR=1.045,95%CI:1.012~1.084,P=0.002)是PHLF发生的独立危险因素。ROC曲线分析结果显示,SV/FRLV预测PHLF的AUC为0.867(95%CI:0.755~0.926,P<0.001),敏感度为0.783,特异度为0.919;SS预测PHLF的AUC为0.856(95%CI:0.715~0.984,P<0.001),敏感度为0.673,特异度为0.862;HIO预测PHLF的AUC为0.694(95%CI:0.542~0.862,P=0.003),敏感度为0.696,特异度为0.741。结论SS与SV/FRLV有助于预测HCC患者PHLF的发生。

Objective To investigate the value of spleen stiffness(SS)and spleen volume(SV)in predicting posthepatectomy liver failure(PHLF)in patients with hepatocellular carcinoma(HCC).Methods Related clinical data were collected from the patients with HCC who underwent hepatectomy in Suzhou Ninth People’s Hospital and The Third Affiliated Hospital of Second Military Medical University from May 2014 to February 2019.SS,liver stiffness(LS),SV,residual remnant liver volume(FRLV),and inflammation markers were measured for all patients before surgery.The independent samples t-test was used for comparison of continuous data between two groups;a Pearson correlation analysis was used to investigate the correlation of SS with LS and SV;univariate and multivariate logistic regression analyses were used to identify the influencing factors for the development of PHLF.The receiver operating characteristic(ROC)curve was used to evaluate the clinical value of SS,SV/FRLV,and hepatic inflow occlusion(HIO),and the area under the ROC curve(AUC),sensitivity,and specificity were calculated.Results A total of 148 patients with HCC were enrolled,among whom 21(14.2%)developed PHLF.Postoperative pathology revealed liver cirrhosis in 73 patients(49.3%).There were significant differences in SV,LS,and SS between the patients with liver cirrhosis and those without liver cirrhosis(t=13.610,6.952,and 20.580,all P<0.001).The correlation analysis showed that SS was positively correlated with LS and SV(r=0.650 and 0.453,P=0.002 and 0.005).The univariate analysis showed that tumor diameter,liver cirrhosis,neutrophil/lymphocyte ratio,LS,SS,SV/FRLV,time of operation,blood transfusion,and HIO duration were associated with the development of PHLF(all P<0.05),and the multivariate logistic regression analysis showed that SV/FRLV(hazard ratio[HR]=26.564,95%confidence interval[CI]:1.611-422.541,P<0.001),SS(HR=1.018,95%CI:1.014-1.154,P=0.008),and HIO duration(HR=1.045,95%CI:1.012-1.084,P=0.002)were independent risk factors for PHLF.The ROC curve analysis showed that SV/FRLV had an AUC of 0.867(95%CI:0.755-0.926,P<0.001),a sensitivity of 0.783,and a specificity of 0.919 in predicting PHLF;SS had an AUC of 0.856(95%CI:0.715-0.984,P<0.001),a sensitivity of 0.673,and a specificity of 0.862 in predicting PHLF;HIO had an AUC of 0.694(95%CI:0.542-0.862,P=0.003),a sensitivity of 0.696,and a specificity of 0.741 in predicting PHLC.Conclusion SS and SV/FRLV can help to predict the development of PHLF in patients with HCC.