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An mALBI-Child-Pugh-based nomogram for predicting post-hepatectomy liver failure grade B-C in patients with huge
Ming-Hao Xu1, Bin Xu1, Chen-Hao Zhou1
1Department of Liver Surgery and Transplantation, Liver Cancer Institute and Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
Insights
A new nomogram accurately predicts post-hepatectomy liver failure (PHLF) grade B-C in patients with huge hepatocellular carcinoma (HCC). This tool aids in managing PHLF risk for patients undergoing major liver surgery.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Liver Failure Prediction
Background:
- Post-hepatectomy liver failure (PHLF) is a critical complication following liver resection for hepatocellular carcinoma (HCC).
- Predicting PHLF, especially grade B-C, in patients with huge HCC (≥10 cm) remains challenging.
- Accurate risk stratification is essential for optimizing surgical outcomes and patient management.
Purpose of the Study:
- To develop and validate a nomogram for predicting PHLF grade B-C in patients with huge HCC.
- To identify independent risk factors associated with PHLF grade B-C in this specific patient cohort.
- To provide a practical, noninvasive tool for pre-operative risk assessment.
Main Methods:
- Retrospective analysis of 514 and 97 patients with huge HCC undergoing hepatectomy across two centers (2016-2021).
- Univariate and multivariate analyses to identify independent predictors of PHLF grade B-C.
- Development and validation of a nomogram incorporating identified risk factors.
Main Results:
- The nomogram integrated pre-operative modified albumin-bilirubin (mALBI) grade, Child-Pugh classification, international normalized ratio (INR), cirrhosis, and intraoperative blood loss.
- The nomogram demonstrated strong predictive performance with an area under the receiver operating characteristic curve of 0.823 (internal validation) and 0.740 (external validation).
- Patients stratified into high-risk groups exhibited significantly higher rates of PHLF grade B-C.
Conclusions:
- A novel, noninvasive nomogram effectively predicts PHLF grade B-C in patients with huge HCC.
- The nomogram, utilizing mALBI-Child-Pugh and other key indicators, offers optimal prediction performance.
- This tool can aid clinicians in assessing and managing PHLF risk in this high-risk surgical population.
Objective:
Post-hepatectomy liver failure (PHLF) is a severe complication in patients with hepatocellular carcinoma (HCC) who underwent hepatectomy. This study aims to develop a nomogram of PHLF grade B-C in patients with huge HCC (diameter ≥ 10 cm).
Methods:
We retrospectively collected clinical information of 514 and 97 patients who underwent hepatectomy for huge HCC at two medical centers between 2016 and 2021. Univariate and multivariate analysis were carried out to screen the independent risk factors of PHLF grade B-C, which were visualized as a nomogram.
Results:
Three Hundred Forty Three Thousand One Hundred Seventy One and 97 HCC patients were included in the training cohort, internal validation cohort, and external validation cohort, with probabilities of PHLF grade B-C of 15.1%, 12.9%, and 22.7%, respectively. Pre-operative modified albumin-bilirubin (mALBI) grade (p < 0.001), Child-Pugh classification (p = 0.044), international normalized ratio (INR) (p = 0.005), cirrhosis (p = 0.019), and intraoperative blood loss (p = 0.004) were found to be independently associated with PHLF grade B-C in the training cohort. All the five independent factors were considered in the establishment of the nomogram model. In the internal validation cohort and external validation cohort, the area under receiver operating characteristic curve for the nomogram in PHLF grade B-C prediction reached 0.823 and 0.740, respectively. Divided into different risk groups according to the optimal cut-off value, patients in the high-risk group reported significantly higher frequency of PHLF grade B-C than those in the low-risk group, both in the training cohort and the validation cohort (p < 0.001).
Conclusions:
The proposed noninvasive nomogram based on mALBI-Child-Pugh and three other indicators achieved optimal prediction performance of PHLF grade B-C in patients with huge HCC.
