[Two-stage multivariant analyses for prediction of hepatic function reserve]

Area of Science:

• Hepatology
• Surgical Oncology
• Biostatistics

Context:

• Primary hepatocellular carcinoma (HCC) often occurs in patients with underlying liver cirrhosis.
• Accurate preoperative assessment of hepatic function reserve is crucial for optimizing surgical outcomes in HCC patients.
• Existing methods may not fully capture the nuances of liver function relevant to surgical risk stratification.

Purpose:

• To identify significant preoperative liver function tests for predicting postoperative outcomes in HCC patients with cirrhosis.
• To develop and validate a "two-stage prediction" model using multiple regression analysis for evaluating liver function reserve.
• To enhance surgical decision-making by providing a more accurate estimation of hepatic function reserve.

Summary:

• Eleven liver function tests were evaluated in 103 HCC patients with cirrhosis.
• Six tests, including glucose tolerance ratio, total bilirubin, albumin/globulin ratio, prealbumin, prothrombin time, and indocyanine green retention, were significant predictors.
• Two multiple regression equations (Y1 and Y2) achieved predictive accuracies of 88.0% and 83.1%, respectively, forming the basis of the "two-stage prediction" method.

Impact:

• The proposed "two-stage prediction" method offers a valuable tool for selecting appropriate surgical procedures, balancing therapeutic efficacy with minimized liver damage.
• Improved preoperative risk stratification can lead to better patient management and potentially reduce postoperative complications.
• This approach aids clinicians in making informed decisions for HCC patients, particularly those with compromised liver function.