A nomogram based on liver stiffness predicts postoperative complications in patients with hepatocellular carcinoma.


Liver stiffness measurement (LSM) assessed by transient elastography (FibroScan®) has been demonstrated to predict post-hepatectomy liver failure (PHLF) in patients who underwent hepatic resection for hepatocellular carcinoma (HCC). However, other complications, besides PHLF, can be related to the underlying grade of liver fibrosis. This study aimed to identify predictors of postoperative complications calculated by the comprehensive complication index (CCI) and to build and develop a novel nomogram able to identify patients at risk of developing severe postoperative complications.Data of patients treated by hepatectomy for HCC between 2006 and 2016 at two referral centres, were retrospectively reviewed. All surgical complications were recorded and scored using the CCI, ranging from 0 (uneventful course) to 100 (death). A CCI ≥26.2 was used as a threshold to define patients having severe complications.During the study period, 471 patients underwent hepatic resection for HCC. Among them, 50 patients (10.6%) had a CCI≥26.2. Age, MELD score and LSM values together with serum albumin were independent predictors of high CCI. The nomogram built on these variables was internally validated and showed good performance (optimism-corrected c-statistic = 0.751). A regression equation to predict the CCI was also established by multiple linear regression analysis: [LSM(kPa)×0.254]+[age(years)×0.118]+[MELD score(pt.)×1.050]-[albumin (g/dL)×2.395]-3.639.This novel nomogram, combining LSM values, age and liver function tests provided an excellent preoperative prediction of high CCI in patients with resectable HCC. This predictive model could be used as a reference for clinicians and surgeons to help them in clinical decision-making.

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