Predictive Model Construction Of Post-hepatectomy Liver Failure

Background:Globally,liver cancer ranks fifth as the most common cancer,and cancer-related deaths rank second.my country accounts for 49% of new liver cancer cases in the world every year.Liver cancer is the fourth most common malignant tumor in China,and it is also the third leading cause of cancer-related death in my country.In the past ten years,the incidence of liver cancer has increased by 2-3% year by year,and the 5-year survival rate is as low as 18%,of which hepatocellular carcinoma(HCC)accounts for 75-85%.Among the many treatment options for HCC at this stage,radical hepatectomy is still the first choice.However,liver cancer combined with chronic liver disease accounted for a major proportion,especially liver cirrhosis,which accounted for about 86%,which could easily lead to post-hepatectomy liver failure(PHLF).Although the perioperative management and the accuracy of intraoperative operations are improving,and the safety and postoperative efficacy of radical hepatectomy are increasing,postoperative liver failure-related deaths still exist,with a mortality rate of 5%.PHLF is still an important cause of death in HCC patients after radical hepatectomy.Research at this stage shows that various clinical comprehensive scoring systems have a certain value in the prediction of PHLF,but there are also certain problems.Therefore,the establishment and improvement of the prediction and judgment system for PHLF is still a hot spot in the field of hepatobiliary surgery..Objective:To investigate the mechanism of the disease from September 2013 to October 2020,213 patients with HCC who underwent hepatectomy in the second hospital of Jilin University and China Japan Friendship Hospital of Jilin University were collected.A new prediction model was constructed by retrospective analysis.Meanwhile,the predictive value of the existing liver reserve function score for the occurrence of PHLF was compared,so as to provide reference for liver surgery In clinical practice,doctors can provide theoretical basis for the evaluation of preoperative liver reserve function and the prediction of liver failure after radical hepatectomy,so as to reduce the postoperative mortality and improve the precision treatment of HCC patients.Materials and methods:A retrospective analysis of the clinical data of 213 patients with HCC who had been treated at the Second Hospital and the China-Japan Union Hospital of Jilin University from September 2013 to October 2020 and received radical hepatectomy with complete data.Use SPSS 23.0 software.A univariate analysis was performed to study the correlation between the occurrence of PHLF and clinical data.The index of P value <0.05 in the results of single factor analysis was retained,and the analysis was incorporated into the multivariate binary logistic regression analysis,and then the independent influencing factors of PHLF were screened out.Then use R 3.6.3 software to establish an intuitive nomogram prediction model for the independent influencing factors of the included PHLF.By calculating its consistency index(concordance index,C-index)and drawing a calibration curve(calibration curve)to evaluate and quantify the accuracy of the nomogram prediction model to predict PHLF.Simultaneous calculation of nomogram prediction model,Child-Pugh score,model for end-stage liver disease prognosis prediction model(model for end-stage liver disease,MELD),albumin-bilirubin score(albuminbilirubin,ALBI),aspartic acid The area under the curve of the receiver operating characteristic curve of the aminotransferase-platelet ratio index(aspartate aminotransferase to platelet ratio index,APRI)was used to compare the predictive ability of the nomogram model and the current liver function reserve score for PHLF.Result:1.History of liver cirrhosis,history of portal hypertension,AST,TBil,DBIL,PA,ALB,CHE,AFP,PLT,indocyanine green rentention rate at 15min(ICG-R15),PT,INR,surgical method,scope of resection,intraoperative blood loss,intraoperative blood transfusion or not,and operation time are closely related to the occurrence of PHLF(P<0.05),gender,history of hepatitis,ascites,age,ALT,I-Bil,BUN,There was no significant correlation between Cre and PHLF(P>0.05);2.The PHLF prediction model contains 4 independent predictors:prealbumin,cholinesterase,ICG-R15,resection range,and the AUC value of the area under the curve of the prediction model is 0.808.The C-index value is 0.869,and the accuracy is good.Draw a calibration curve,and the calibration curve fits well with the ideal curve,indicating that the nomogram prediction model has a good predictive effect on the occurrence of PHLF;3.Draw the nomogram prediction model,the current ROC curve of liver reserve function scores(Child-Pugh score,MELD score,ALBI score,APRI score),and calculate the AUC value of the area under the ROC curve.The AUC of the prediction model is 0.808,the AUC of the MELD score is0.626,the AUC of the ALBI score is 0.723,the AUC of the APRI score is0.687,and the AUC of the CHild-Pugh classification is 0.617,indicating that the above prediction models and scoring systems have predictive value,and the nomogram predicts The model has a better predictive effect on the research objects of the center.4.For Child-Pugh Class A patients,the application value of the nomogram prediction model,MLED,ALBI,APRI score and other classic liver failure prediction criteria after hepatectomy were compared.The results found that the sensitivity of the nomogram prediction model was higher than that of MELD,ALBI,and APRI scores,indicating that it has the highest accuracy in distinguishing PHLF patients.The MELD score has the highest specificity,which proves that its accuracy in distinguishing non-PHLF patients is higher than the ALBI,APRI score and nomogram prediction models.The positive predictive value and negative predictive value of the nomogram prediction model are higher than the MELD,ALBI,and APRI scores,indicating that the patients who predict PHLF in the second way are most likely to be PHLF patients,while predicting nonPHLF patients,its Patients who are truly non-PHLF are most likely to be,which indicates that the prediction result is better by this method Conclusion:1.Prealbumin,cholinesterase,ICG-R15,and the range of resection are independent predictors of PHLF in HCC patients,and can be used as relevant indicators for early prediction of PHLF;2.Based on the PHLF nomogram prediction model,the optimal threshold is determined,-0.335,which is an important reference index for judging PHLF before surgery;3.Compared with ALBI score,MELD score and APRI score,the nomogram prediction model has higher sensitivity,positive predictive value and negative predictive value,relatively high specificity,and has better clinical application value.