The Effects of Liver Function Damage after Thermal Ablation on the Prognosis of HCC Patients and Its Prediction

doi:10.37015/AUDT.2021.210017

Abstract

Abstract:

Objective: To investigate the influence of liver function damage in patients with hepatocellular carcinoma (HCC) after microwave ablation (MWA) on the prognosis and to establish an algorithm to predict liver function damage.
Methods: This is a retrospective study. A total of 745 patients were enrolled and classified into the modeling group and the validation group. The risk factors of liver function damage were analyzed by using logistic regression model. The β coefficients derived from a logistic analysis were used to calculate the risk score. Diagnostic accuracy based on risk score was assessed by the area under the curve (AUC).
Results: 69 patients in the modeling group suffered from liver function damage. The 1-,3-,5- and 7-year progression free survival were 69.4%, 37.2%, 22.6% and 12.4% for patients without liver function damage and 69.5%, 33.0%, 14.4% and 0% for patients with liver function damage, respectively (P = 0.537). The 1-, 3-, 5- and 7-year overall survival were 94.3%, 75.9%, 61.5% and 54.5% for patients without liver function damage and 81.3%, 57.1%, 42.7% and 42.7% for those with liver function damage (P = 0.004), respectively. The AUC of the risk score for predicting liver function damage was 0.798 for the modeling group and 0.832 for the validation group. The sensitivity and specificity of the risk score to identify liver function damage was 65.2%, 84.4% in the modeling group and 60.6%, 88.3% in the validation group, respectively.
Conclusion: Liver function damage after MWA is unfavorable the long-term prognosis. The prediction algorithm based on five risk factors is robust and can be used to predict possible liver function damage.

Key words: Microwave ablation; Hepatocellular carcinoma; Liver function damage; Prediction algorithm

Yan Zhou, Jianmin Ding, Fengmei Wang, Zhengyi Qin, Yandong Wang, Hongyu Zhou, Xiang Jing. The Effects of Liver Function Damage after Thermal Ablation on the Prognosis of HCC Patients and Its Prediction. Advanced Ultrasound in Diagnosis and Therapy, 2021, 5(2): 80-86.

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Item	Modeling group	Validation group	P value
Number of patients	598	247
Number of tumors	721	359
Gender (M/F)	374/124	190/57	0.585
Age (years)	59.56 ± 9.07	60.02 ± 8.84	0.497
Etiology			0.477
HBV	410	209
HCV	55	28
Alcoholic	9	4
Other	24	6
Tumor size (cm)	2.39 ± 0.82	2.20 ± 0.83	0.007
Child-pugh classification (A/B)	432/66	220/27	0.367
ALB (g/L)	39.84 ± 5.99	40.88 ± 5.66	0.023
ALT (U/L)	32.68 ± 22.01	31.32 ± 29.26	0.476
AST (U/L)	36.14 ± 22.54	33.03 ± 22.17	0.075
TBIL (μmol/L)	18.87 ± 10.40	20.91 ± 13.37	0.022
PLT (10⁹/L)	108.16 ± 58.66	115.59 ± 68.80	0.126

Factor	Categorized
Relative position between the tumor and PV ^a	(1) far away from PV; (2) close to the third branch of PV (< 5 mm); (3) close to the second branch of PV (< 5 mm); (4) close to the first branch of PV (< 5 mm).
Number of tumor	(1) solitary tumor; (2) 2 or 3 tumors; (3) more than 3 tumors
Ablation volume ^b	(1) < 22.5 cm³; (2) ≥ 22.5 cm³
APRI b	(1) APRI≤0.8; (2) 0.8 < APRI≤1.6; (3) APRI > 1.6
MELD score ^b	(1) MELD score < 25; (2)25≤MELD score < 30; (3) MELD score > 30
PLT b	(1) PLT < 110 × 10⁹/L; (2) PLT≥110 × 10⁹/L
Child Classification	(1) Child A; (2) Child B

Variable	Univariate analysis			Multiple analysis
Variable	β coefficients	Odds ratio	P value	β coefficients	Odds ratio	P value
Relative position between the tumor and PV
Far away	1.00	1.00		1.00	1.00
Close to the third branch	1.36	3.89	< 0.001	1.40	4.09	< 0.001
Close to the second branch	2.40	11.01	< 0.001	2.83	16.93	< 0.001
Close to the first branch	1.55	4.72	0.079	1.24	3.48	0.198
Number of tumors
1	1.00	1.00		1.00	1.00
2 or 3	0.92	2.50	0.010	0.77	2.17	0.019
More than 3	2.10	8.14	< 0.001	1.56	4.76	0.027
Ablation volume	1.10	3.02	< 0.001	0.74	2.09	0.025
Child-Pugh Classification	0.83	2.29	0.010	0.34	1.40	0.432
APRI
≤0.8	1.00	1.00		1.00	1.00
≤1.6	0.68	1.98	0.059	0.28	1.33	0.544
> 1.6	1.87	6.48	< 0.001	1.62	5.05	0.001
Platelet	1.11	3.03	< 0.001	0.13	1.14	0.780
MELD score
< 25	1.00	1.00		1.00	1.00
< 30	1.04	2.84	0.001	0.91	2.45	0.049
≥30	1.56	4.77	< 0.001	1.08	2.93	0.050

Variable	β coefficients	Score
Relative position between the tumor and PV
Far away		1
Close to the third branch	1.40	14
Close to the second branch	2.83	28
Close to the first branch	1.24	12
Number of tumors		1
1
2 or 3	0.77	8
More than 3	1.56	16
Ablation volume
< 22.5 cm³		1
≥ 22.5 cm³	0.74	7
Child-Pugh Classification
Child A		1
Child B	0.34	3
APRI
≤0.8		1
≤1.6	0.28	3
> 1.6	1.62	16