Yinghao Shen1,2, Chenhao Zhou1,2, Guodong Zhu3, Guoming Shi1,2, Xiaodong Zhu1,2, Cheng Huang1,2, Jian Zhou1,2, Jia Fan1,2, Hong Ding4, Ning Ren5,6, Hui-Chuan Sun7,8. 1. Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, 200032, China. 2. Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, China. 3. The Third Affiliated Hospital, Nantong University, Nantong, Jiangsu Province, China. 4. Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China. 5. Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, 200032, China. ren.ning@zs-hospital.sh.cn. 6. Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, China. ren.ning@zs-hospital.sh.cn. 7. Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, 200032, China. sun.huichuan@zs-hospital.sh.cn. 8. Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, China. sun.huichuan@zs-hospital.sh.cn.
Abstract
BACKGROUND: Cirrhosis increases a patient's risk of developing postoperative liver failure (PLF). Liver stiffness (LS), assessed by two-dimensional shear wave elastography (SWE), indicates liver fibrosis with high accuracy. Whether LS is superior to portal hypertension (PHT) in predicting PLF remains to be studied. METHODS: The study enrolled 280 patients who underwent hepatectomy for hepatocellular carcinoma from July 2015 to July 2016. All patients received preoperative assessments for LS, PHT, and serum markers of liver fibrosis in addition to other clinicopathological tests. Risk factors for grade A and grade B (or greater) PLF were subjected to univariate and multivariate analysis and receiver operating characteristic curve analysis. RESULTS: Fifty-five patients (19.6%) experienced PLF. The cutoff value of LS for predicting cirrhosis was 10.1 kPa. Multivariate analysis identified LS, hyaluronic acid, IV collagen, and the presence of splenomegaly as independent predictors of PLF. The cutoff value of LS for predicting PLF and grade B (or greater) PLF was 11.75 and 11.9 kPa, respectively. LS was superior to PHT in predicting PLF or greater than grade B PLF (0.72 vs. 0.60, 0.76 vs. 0.59, P < 0.05). CONCLUSION: LS measured by SWE can predict risk of PLF with greater accuracy than PHT.
BACKGROUND:Cirrhosis increases a patient's risk of developing postoperative liver failure (PLF). Liver stiffness (LS), assessed by two-dimensional shear wave elastography (SWE), indicates liver fibrosis with high accuracy. Whether LS is superior to portal hypertension (PHT) in predicting PLF remains to be studied. METHODS: The study enrolled 280 patients who underwent hepatectomy for hepatocellular carcinoma from July 2015 to July 2016. All patients received preoperative assessments for LS, PHT, and serum markers of liver fibrosis in addition to other clinicopathological tests. Risk factors for grade A and grade B (or greater) PLF were subjected to univariate and multivariate analysis and receiver operating characteristic curve analysis. RESULTS: Fifty-five patients (19.6%) experienced PLF. The cutoff value of LS for predicting cirrhosis was 10.1 kPa. Multivariate analysis identified LS, hyaluronic acid, IV collagen, and the presence of splenomegaly as independent predictors of PLF. The cutoff value of LS for predicting PLF and grade B (or greater) PLF was 11.75 and 11.9 kPa, respectively. LS was superior to PHT in predicting PLF or greater than grade B PLF (0.72 vs. 0.60, 0.76 vs. 0.59, P < 0.05). CONCLUSION:LS measured by SWE can predict risk of PLF with greater accuracy than PHT.
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