Predictors of Futile Liver Resection for Patients with Barcelona Clinic Liver Cancer Stage B/C Hepatocellular Carcinoma

• DOI: 10.1007/s11605-017-3632-6
• Publication Date: 2017-11-08T20:40:33Z
• Authors: Chuan Li; Jun-Yi Shen; Xiao-Yun Zhang; Wei Peng; Tian-Fu Wen; Jia-Yin Yang; Lu-Nan Yan
• Keywords: Adult; Male; Venous Thrombosis; Carcinoma, Hepatocellular; Portal Vein; Liver Neoplasms; Middle Aged; Risk Assessment; 3. Good health; Nomograms; 03 medical and health sciences; 0302 clinical medicine; ROC Curve; Multivariate Analysis; Hepatectomy; Humans; Female; alpha-Fetoproteins; Neoplasm Staging

There is little information concerning futile liver resection for patients with Barcelona Clinic Liver Cancer (BCLC) stage B/C hepatocellular carcinoma (HCC). This study aimed to establish a predictive model of futile liver resection for patients with BCLC stage B/C HCC.The outcomes of 484 patients with BCLC stage B/C HCC who underwent liver resection at our centre between 2010 and 2016 were reviewed. Patients were randomised and divided 2:1 into training and validation sets. A novel risk-scoring model and prognostic nomogram were developed based on the results of multivariate analysis.Fifty-seven futile operations were observed. Multivariate analyses revealed tumour numbers > 3, Vp4 portal vein tumour thrombosis (PVTT) and alpha-fetoprotein (AFP) > 400 ng/ml independently associated with futile liver resection. A risk-scoring model based on the above-mentioned factors was developed (predictive risk score = 1 × (if AFP > 400 ng/ml) + 2 × (if tumour number > 3) + 3 × (if with Vp4 PVTT)). The area under the receiver-operating characteristic curve of this model was 0.845, with a sensitivity of 60.0% and a specificity of 94.8%. A prognostic nomogram was also developed and achieved a C-index of 0.831. The validation studies optically supported these results.A risk-scoring model and predictive nomogram for futile liver resection were developed in the present study. T`he BCLC stage B/C HCC patients with a high risk obtained no benefit from liver resection.