不同肝体积评估指标预测肝癌术后肝功能衰竭的效能分析

Efficacy of different liver-volume assessment indicators in predicting post-hepatectomy hepatic failure

目的评估残肝分数(remnant liver volume to total liver volume,%RLV)、残肝体积/标准肝体积(remnant liver volume to standard liver volume,RLV/SLV)、残肝体积/体重比率(remnant liver volume to body weight ratio,RLV/BW)、标准残肝体积(standard remnant liver volume,SRLV)预测肝细胞癌(hepatocellular carcinoma,HCC)患者行半肝切除术后发生肝功能衰竭(post-hepatectomy liver failure,PHLF)的效能。方法收集2013年9月至2016年8月于广西医科大学附属肿瘤医院行肝切除术的1446例乙型肝炎病毒相关性HCC患者(HBV-HCC),根据是否发生PHLF分为PHLF组和无PHLF组。采用ROC曲线分析%RLV、RLV/SLV、RLV/BW、SRLV预测术后肝功能衰竭的效能,并比较术后并发症发生率。结果本研究共纳入181例HBV-HCC患者,其中PHLF组22例,无PHLF组159例,两组患者%RLV、RLV/SLV、RLV/BW、SRLV比较差异有统计学意义(P<0.05)。ROC曲线分析显示,%RLV、RLV/SLV、RLV/BW、SRLV的AUC分别为0.77、0.91、0.84、0.91,SRLV预测术后PHLF的效能优于%RLV及RLV/BW,差异有统计学意义(P<0.05)。以SRLV截点值340 mL/m^2分组,SRLV>340 mL/m^2组及SRLV≤340 mL/m^2组患者术后重度并发症发生率差异有统计学意义(P<0.01)。结论SRLV及RLV/SLV较RLV/BW及%RLV在预测HCC患者接受半肝切除术后发生肝功能衰竭中具有更高的效能,当SRLV≤340 mL/m^2时患者术后肝功能衰竭及重度并发症发生率更高。

Objective To evaluate the efficacy of the %RLV(remnant liver volume to total liver volume),RLV/SLV(remnant liver volume to standard liver volume),RLV/BW(remnant liver volume to body weight ratio),and SRLV(standard remnant liver volume)in predicting post-hepatectomy liver failure(PHLF)in hepatocellular carcinoma(HCC)patients under hemihepatectomy. Method Totals of 1,446 patients with hepatitis B virus-associated HCC,who underwent hemihepatectomy in Guangxi Medical University Cancer Hospital from September 2013 to August 2016,were collected and divided into a PHLF group and a PHLF-free group according to whether PHLF occurred after hemihepatectomy. The ROC curve was used to analyze the efficacy of %RLV,RLV/BW,RLV/SLV and SRLV in predicting PHLF. The incidence of postoperative complications between the two groups of patients were compared. Result A total of 181 patients were enrolled in the study,including 22 cases in the PHLF group and 159 cases in the PHLF-free group. There was a statistically significant difference in %RLV,RLV/BW,RLV/SLV,and SRLV between the two groups(P<0.05). ROC curve analysis showed that the areas under the curves(AUC)of %RLV,RLV/SLV,RLV/BW,and SRLV were 0.77,0.91,0.84,and 0.91,respectively.The effectiveness of SRLV in predicting postoperative PHLF was better than %RLV and RLV/BW(P<0.05). According to the SRLV cutoff value of 340 mL/m^2,patients were divided into SRLV>340 mL/m^2 group and SRLV≤340 mL/m^2 group. The incidence of severe postoperative complications in patients with SRLV>340 mL/m^2 was statistically significant compared with SRLV≤340 mL/m^2(P<0.01).Conclusion SRLV and RLV/SLV are more effective than RLV/BW and %RLV in predicting PHLF in HCC patients after hepatectomy,and the incidence of PHLF and severe complications are higher when SRLV≤340 mL/m^2.