Xihua Zheng,* Yumin Zhang,* Huiying Huang, Ningbin Luo

Departments of Radiology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Ningbin Luo, Departments of Radiology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, People’s Republic of China, Fax +860734-5312000, Email luoningbin2012@hotmail.com

Purpose: To develop a model based on Functional Liver Imaging Score (FLIS) to estimate the risk of clinically significant post-hepatectomy liver failure (PHLF) for hepatocellular carcinoma (HCC) after resection.
Patients and Methods: This retrospective study analyzed 885 patients with HCC who undergoing liver resection at our medical center between January 2017 and December 2021. Patients were randomly (7:3) assigned to development (n=620) or internal validation (n=265) cohorts. Univariable and multivariable logistic regression analyses were performed to identify independent risk factors for clinically significant PHLF, defined as grade B or C PHLF by the International Study Group of Liver Surgery. Predictive performance was assessed by the area under receiver operator characteristic curves (AUC).
Results: Clinically significant PHLF occurred in 7.7% of the development cohort and 7.2% of the internal validation cohort. Multivariate analysis identified FLIS, major resection and ALBI score as independent predictors of clinically significant PHLF, and a model combining these three variables predicted failure in the development cohort (AUC 0.746, 95% CI 0.673– 0.820) and internal validation cohort (AUC 0.717, 95% CI 0.595– 0.838). The same model also predicted mortality within 90 days after surgery in the development cohort (AUC 0.704, 95% CI 0.575– 0.832) and internal validation cohort (AUC 0.717, 95% CI 0.586– 0.848). In both cohorts, overall survival rate was significantly lower among patients whom the model placed at high risk of clinically significant PHLF than among those at low risk.
Conclusion: The combination of FLIS and other easily acquired clinical data may reliably predict clinically significant PHLF and mortality in hepatocellular carcinoma.
Plain Language Summary: Functional liver imaging score derived from gadoxetic acid-enhanced MRI can effectively and conveniently evaluate liver function. In this study, functional liver imaging score, major resection and ALBI score were significantly associated with clinically significant post-hepatectomy liver failure for hepatocellular carcinoma after resection. A model combining these factors reliably predicted clinically significant post-hepatectomy liver failure and 90-day mortality in our cohort.

Keywords: hepatocellular carcinoma, hepatectomy, post-hepatectomy liver failure, functional liver imaging scores, magnetic resonance imaging, prognosis