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Prediction models determine long-term outcomes after liver resection

A set of three prediction models for patients who required liver resection for hepatocellular carcinoma with Child-Pugh B cirrhosis estimated postoperative surgical risks and long-term survival rates.

“When [liver transplantation] is not an option as primary treatment, the appeal to non-curative treatments should be pondered with the figures of survival,” Giammauro Berardi, MD, from Ghent University and Federico II University in Italy, and colleagues wrote. “In either scenario, liver resection represents a valid choice that could be safely considered in the appropriate setting. Accurate patients’ selection according to preoperative baseline characteristics, tumor burden and liver functional tests, as well as minimization of the surgical stress, could lead to improvements in postoperative morbidity achieving safe oncological outcomes.”

The study comprised 253 patients, most of whom underwent minor hepatectomy (84.6%) and nearly half underwent a minimally invasive technique (48.2%). During the study period, 42.7% experienced complications, with a major morbidity rate of 7.3%.

Variables including comorbidities, Child-Pugh score, platelet count, ascites, portal hypertension and type of hepatectomy increased the risk for postoperative complications, whereas preoperative hemoglobin decreased the risk. This model had good prediction capability (c-index = 0.79; 95% CI, 0.73-0.84).

The model for predicting 3-year and 5-year survival had moderate capability (c-index = 0.67; 95% CI, 0.62-0.73) and included Child-Pugh score, preoperative alpha-fetoprotein value, number and size of lesions, along with clinically relevant variables such as comorbidities, preoperative portal hypertension and previous HCC treatment.

Finally, the researchers developed a model for predicting 3-year and 5-year disease-free survival including preoperative alpha-fetoprotein value and size of lesions (c-index = 0.59; 95% CI, 0.54-0.64).

“It is a matter of fact that [Child Pugh]-B cirrhosis has been named by some authors as a contraindication to surgery for both the negative cancer prognosis and the high morbidity rate,” Berardi and colleagues noted. “Despite this, we believe that a negative predictor should not be seen as an absolute contraindication but should rather be compared to the other available options; efforts should be made to achieve improvements in outcomes rather than excluding a potentially curative treatment.” – by Talitha Bennett

Disclosures: The authors report no relevant financial disclosures.