Rong-Yun Mai1, Hua-Ze Lu2, Tao Bai2, Rong Liang3, Yan Lin3, Liang Ma2, Bang-de Xiang2, Guo-Bin Wu2, Le-Qun Li2, Jia-Zhou Ye4. 1. Department of Hepatobiliary & Pancreatic Surgery, Guangxi Medical University Cancer Hospital, Nanning, China; Department of Experimental Research, Guangxi Medical University Cancer Hospital, Nanning, China; Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Center, Nanning, China. 2. Department of Hepatobiliary & Pancreatic Surgery, Guangxi Medical University Cancer Hospital, Nanning, China; Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Center, Nanning, China. 3. Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Center, Nanning, China; Department of First Chemotherapy, Guangxi Medical University Cancer Hospital, Nanning, China. 4. Department of Hepatobiliary & Pancreatic Surgery, Guangxi Medical University Cancer Hospital, Nanning, China; Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Center, Nanning, China. Electronic address: yejiazhou2019@163.com.
Abstract
BACKGROUND: Posthepatectomy liver failure is a worrisome complication after major hepatectomy for hepatocellular carcinoma and is the leading cause of postoperative mortality. Recommendations for hepatectomy for hepatocellular carcinoma are based on the risk of severe posthepatectomy liver failure, and accurately predicting posthepatectomy liver failure risk before undertaking major hepatectomy is of great significance. Thus, herein, we aimed to establish and validate an artificial neural network model to predict severe posthepatectomy liver failure in patients with hepatocellular carcinoma who underwent hemihepatectomy. METHODS: Three hundred and fifty-three patients who underwent hemihepatectomy for hepatocellular carcinoma were included. We randomly divided the patients into a development set (n = 265, 75%) and a validation set (n = 88, 25%). Multivariate logistic analysis facilitated identification of independent variables that we incorporated into the artificial neural network model to predict severe posthepatectomy liver failure in the development set and then verified in the validation set. RESULTS: The morbidity of patients with severe posthepatectomy liver failure in the development and validation sets was 24.9% and 23.9%, respectively. Multivariate analysis revealed that platelet count, prothrombin time, total bilirubin, aspartate aminotransferase, and standardized future liver remnant were all significant predictors of severe posthepatectomy liver failure. Incorporating these factors, the artificial neural network model showed satisfactory area under the receiver operating characteristic curve for the development set of 0.880 (95% confidence interval, 0.836-0.925) and for the validation set of 0.876 (95% confidence interval, 0.801-0.950) in predicting severe posthepatectomy liver failure and achieved well-fitted calibration ability. The predictive performance of the artificial neural network model for severe posthepatectomy liver failure outperformed the traditional logistic regression model and commonly used scoring systems. Moreover, stratification into 3 risk groups highlighted significant differences between the incidences and grades of posthepatectomy liver failure. CONCLUSION: The artificial neural network model accurately predicted the risk of severe posthepatectomy liver failure in patients with hepatocellular carcinoma who underwent hemihepatectomy. Our artificial neural network model might help surgeons identify intermediate and high-risk patients to facilitate earlier interventions.
BACKGROUND: Posthepatectomy liver failure is a worrisome complication after major hepatectomy for hepatocellular carcinoma and is the leading cause of postoperative mortality. Recommendations for hepatectomy for hepatocellular carcinoma are based on the risk of severe posthepatectomy liver failure, and accurately predicting posthepatectomy liver failure risk before undertaking major hepatectomy is of great significance. Thus, herein, we aimed to establish and validate an artificial neural network model to predict severe posthepatectomy liver failure in patients with hepatocellular carcinoma who underwent hemihepatectomy. METHODS: Three hundred and fifty-three patients who underwent hemihepatectomy for hepatocellular carcinoma were included. We randomly divided the patients into a development set (n = 265, 75%) and a validation set (n = 88, 25%). Multivariate logistic analysis facilitated identification of independent variables that we incorporated into the artificial neural network model to predict severe posthepatectomy liver failure in the development set and then verified in the validation set. RESULTS: The morbidity of patients with severe posthepatectomy liver failure in the development and validation sets was 24.9% and 23.9%, respectively. Multivariate analysis revealed that platelet count, prothrombin time, total bilirubin, aspartate aminotransferase, and standardized future liver remnant were all significant predictors of severe posthepatectomy liver failure. Incorporating these factors, the artificial neural network model showed satisfactory area under the receiver operating characteristic curve for the development set of 0.880 (95% confidence interval, 0.836-0.925) and for the validation set of 0.876 (95% confidence interval, 0.801-0.950) in predicting severe posthepatectomy liver failure and achieved well-fitted calibration ability. The predictive performance of the artificial neural network model for severe posthepatectomy liver failure outperformed the traditional logistic regression model and commonly used scoring systems. Moreover, stratification into 3 risk groups highlighted significant differences between the incidences and grades of posthepatectomy liver failure. CONCLUSION: The artificial neural network model accurately predicted the risk of severe posthepatectomy liver failure in patients with hepatocellular carcinoma who underwent hemihepatectomy. Our artificial neural network model might help surgeons identify intermediate and high-risk patients to facilitate earlier interventions.
Authors: M Wagner; A Schulze; S Bodenstedt; L Maier-Hein; S Speidel; F Nickel; F Berlth; B P Müller-Stich; Peter Grimminger Journal: Chirurg Date: 2022-01-24 Impact factor: 0.955
Authors: Lena Maier-Hein; Matthias Eisenmann; Duygu Sarikaya; Keno März; Toby Collins; Anand Malpani; Johannes Fallert; Hubertus Feussner; Stamatia Giannarou; Pietro Mascagni; Hirenkumar Nakawala; Adrian Park; Carla Pugh; Danail Stoyanov; Swaroop S Vedula; Kevin Cleary; Gabor Fichtinger; Germain Forestier; Bernard Gibaud; Teodor Grantcharov; Makoto Hashizume; Doreen Heckmann-Nötzel; Hannes G Kenngott; Ron Kikinis; Lars Mündermann; Nassir Navab; Sinan Onogur; Tobias Roß; Raphael Sznitman; Russell H Taylor; Minu D Tizabi; Martin Wagner; Gregory D Hager; Thomas Neumuth; Nicolas Padoy; Justin Collins; Ines Gockel; Jan Goedeke; Daniel A Hashimoto; Luc Joyeux; Kyle Lam; Daniel R Leff; Amin Madani; Hani J Marcus; Ozanan Meireles; Alexander Seitel; Dogu Teber; Frank Ückert; Beat P Müller-Stich; Pierre Jannin; Stefanie Speidel Journal: Med Image Anal Date: 2021-11-18 Impact factor: 13.828