Development of a nomogram to predict outcome after liver resection for hepatocellular carcinoma in child-pugh b cirrhosis.

BACKGROUND & AIMS

Treatment allocation of patients with hepatocellular carcinoma (HCC) on Child-Pugh B (CP-B) cirrhosis is controversial. Liver resection has been proposed by small series with acceptable outcomes, but data are limited. The aim of this study was to evaluate the outcomes of patients undergoing liver resection for HCC in CP-B cirrhosis focusing on the surgical risks and survivals.

METHODS

Patients were retrospectively pooled from 14 international referral centers from 2002 to 2017. Postoperative and oncological outcomes were investigated. Prediction models for surgical risks and survivals were constructed.

RESULTS

253 patients were included. 57.3% of patients had a preoperative platelet count <100.000/mm3, 43.5% had preoperative ascites, and 56.9% had portal hypertension. A minor hepatectomy was most commonly performed (84.6%) and 122 (48.2%) were operated on by minimally invasive surgery (MIS). 90 days mortality was 4.3% with six patients (2.3%) dying from liver failure. 108 patients (42.7%) experienced complications of which the most common was ascites (37.5%). Patients undergoing major hepatectomies had higher 90 days mortality (10.3% vs. 3.3%; p=0.04) and morbidity rate (69.2% vs. 37.9%; p<0.001). Patients undergoing an open hepatectomy had higher morbidity (52.7% vs. 31.9%; p=0.001) compared to MIS. A prediction model for surgical risk was constructed (https://childb.shinyapps.io/morbidity/). The 5-year overall survival (OS) rate was 47%, and 56.9% of patients experienced recurrence. Prediction models for OS (https://childb.shinyapps.io/survival/) and disease-free survival (https://childb.shinyapps.io/DFsurvival/) were constructed.

CONCLUSIONS

Liver resection for HCC in CP-B cirrhosis should be considered after careful selection according to patients' characteristics, tumor pattern and liver function as well as minimizing surgical stress. An estimation of the surgical risk and survival advantage may be helpful in treatment allocation eventually improving postoperative morbidity achieving safe oncological outcomes.

LAY SUMMARY

Liver resection for hepatocellular carcinoma in advanced cirrhosis (Child-Pugh B score) is associated with a high rate of postoperative complications. However, due to the limited therapeutic alternatives in this setting, recent studies have shown promising results after accurate patients' selection. In our international multicenter study we provide three clinical models to predict postoperative surgical risks and long-term survivals following liver resection to help in treatment allocation eventually improving the outcomes.