M W Fromer1, T A Aloia2, J P Gaughan3, U M Atabek4, F R Spitz5. 1. Department of Surgery, Cooper University Hospital, 3 Cooper Plaza, Suite 411, Camden, NJ, 08103, USA. Electronic address: fromer-marc@cooperhealth.edu. 2. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Herman Pressler, Unit 1484, Houston, TX, 77030, USA. Electronic address: TAAloia@mdanderson.org. 3. Department of Surgery, Cooper University Hospital, 3 Cooper Plaza, Suite 411, Camden, NJ, 08103, USA. Electronic address: gaughan-john@cooperhealth.edu. 4. Department of Surgery, Cooper University Hospital, 3 Cooper Plaza, Suite 411, Camden, NJ, 08103, USA. Electronic address: atabek-umur@cooperhealth.edu. 5. Department of Surgery, Cooper University Hospital, 3 Cooper Plaza, Suite 411, Camden, NJ, 08103, USA. Electronic address: Spitz-Francis@cooperhealth.edu.
Abstract
BACKGROUND: The MELD score has been demonstrated to be predictive of hepatectomy outcomes in mixed patient samples of primary and secondary liver cancers. Because MELD is a measure of hepatic dysfunction, prior conclusions may rely on the high prevalence of cirrhosis observed with primary lesions. This study aims to evaluate MELD score as a predictor of mortality and develop a risk prediction model for patients specifically undergoing hepatic metastasectomy. METHODS: ACS-NSQIP 2005-2013 was analyzed to select patients who had undergone liver resections for metastases. A receiver operating characteristic (ROC) analysis determined the MELD score most associated with 30-day mortality. A literature review identified variables that impact hepatectomy outcomes. Significant factors were included in a multivariable analysis (MVA). A risk calculator was derived from the final multivariable model. RESULTS: Among the 14,919 patients assessed, the mortality rate was 2.7%, and the median MELD was 7.3 (range = 34.4). A MELD of 7.24 was identified by ROC (sensitivity = 81%, specificity = 51%, c-statistic = 0.71). Of all patients above this threshold, 4.4% died at 30 days vs. 1.1% in the group ≤7.24. This faction represented 50.1% of the population but accounted for 80.3% of all deaths (p < 0.001). The MVA revealed mortality to be increased 2.6-times (OR = 2.55, 95%CI 1.69-3.84, p < 0.001). A risk calculator was successfully developed and validated. CONCLUSIONS: MELD>7.24 is an important predictor of death following hepatectomy for metastasis and may prompt a detailed assessment with the provided risk calculator. Attention to MELD in the preoperative setting will improve treatment planning and patient education prior to oncologic liver resection.
BACKGROUND: The MELD score has been demonstrated to be predictive of hepatectomy outcomes in mixed patient samples of primary and secondary liver cancers. Because MELD is a measure of hepatic dysfunction, prior conclusions may rely on the high prevalence of cirrhosis observed with primary lesions. This study aims to evaluate MELD score as a predictor of mortality and develop a risk prediction model for patients specifically undergoing hepatic metastasectomy. METHODS: ACS-NSQIP 2005-2013 was analyzed to select patients who had undergone liver resections for metastases. A receiver operating characteristic (ROC) analysis determined the MELD score most associated with 30-day mortality. A literature review identified variables that impact hepatectomy outcomes. Significant factors were included in a multivariable analysis (MVA). A risk calculator was derived from the final multivariable model. RESULTS: Among the 14,919 patients assessed, the mortality rate was 2.7%, and the median MELD was 7.3 (range = 34.4). A MELD of 7.24 was identified by ROC (sensitivity = 81%, specificity = 51%, c-statistic = 0.71). Of all patients above this threshold, 4.4% died at 30 days vs. 1.1% in the group ≤7.24. This faction represented 50.1% of the population but accounted for 80.3% of all deaths (p < 0.001). The MVA revealed mortality to be increased 2.6-times (OR = 2.55, 95%CI 1.69-3.84, p < 0.001). A risk calculator was successfully developed and validated. CONCLUSIONS: MELD>7.24 is an important predictor of death following hepatectomy for metastasis and may prompt a detailed assessment with the provided risk calculator. Attention to MELD in the preoperative setting will improve treatment planning and patient education prior to oncologic liver resection.
Authors: Anton Faron; Claus C Pieper; Frederic C Schmeel; Alois M Sprinkart; Daniel L R Kuetting; Rolf Fimmers; Jonel Trebicka; Hans H Schild; Carsten Meyer; Daniel Thomas; Julian A Luetkens Journal: Eur Radiol Date: 2019-01-28 Impact factor: 5.315
Authors: Linda M Pak; Jayasree Chakraborty; Mithat Gonen; William C Chapman; Richard K G Do; Bas Groot Koerkamp; Kees Verhoef; Ser Yee Lee; Marco Massani; Eric P van der Stok; Amber L Simpson Journal: J Am Coll Surg Date: 2018-02-15 Impact factor: 6.113
Authors: Amir A Rahnemai-Azar; Jordan M Cloyd; Sharon M Weber; Mary Dillhoff; Carl Schmidt; Emily R Winslow; Timothy M Pawlik Journal: J Clin Transl Hepatol Date: 2017-11-30
Authors: Tanja Knoblich; Ulf Hinz; Christos Stravodimos; Michael R Schön; Arianeb Mehrabi; Markus W Büchler; Katrin Hoffmann Journal: BMC Surg Date: 2020-01-29 Impact factor: 2.102
Authors: Dimitrios Moris; Brian I Shaw; Cecilia Ong; Ashton Connor; Mariya L Samoylova; Samuel J Kesseli; Nader Abraham; Jared Gloria; Robin Schmitz; Zachary W Fitch; Bryan M Clary; Andrew S Barbas Journal: Hepatobiliary Surg Nutr Date: 2021-06 Impact factor: 7.293