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Association between spleen volume and the post-hepatectomy liver failure and overall survival of patients with hepatocellular carcinoma after resection

  • Gastrointestinal
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Abstract

Objectives

Post-hepatectomy liver failure (PHLF) can occur as a major complication after hepatic resection (HR) in patients with hepatocellular carcinoma (HCC) and negatively affects the prognosis. We aimed to retrospectively assess whether the spleen volume (SV) measured from preoperative CT images would be associated with the development of PHLF and overall survival (OS) after HR in patients with HCC.

Methods

We enrolled 317 consecutive patients with very early/early stage HCC who underwent a preoperative CT and HR between January 2010 and December 2016. The SV was obtained from preoperative CT images using semi-automated volumetric software and was divided by body surface area to yield SVBSA. Receiver operating characteristic (ROC) curves and logistic regression analyses were performed to identify factors affecting the development of PHLF. The Cox proportional hazard model was used to identify prognostic factors for OS.

Results

PHLF was observed in 72 patients (22.7% [72/317]). SVBSA was associated with the development of PHLF (odds ratio, 2.321; 95% CI, 1.347–4.001; p = 0.002) with the area under the ROC curve of 0.663 using the cutoff value of 107.5 cm3 (p < 0.001). SVBSA was also an influencing factor for OS (hazard ratio, 3.935; 95% CI 1.520–10.184; p = 0.005), with the optimal cutoff of 146 cm3. The 5-year OS rate was higher in 245 patients with a SVBSA ≤ 146 cm3 than in 72 patients with a SVBSA > 146 cm3 (95.0% vs. 78.7%, p < 0.001).

Conclusions

In patients with HCC, a larger SVBSA was associated with a higher rate of PHLF and worse OS after HR. The SVBSA may be useful in selecting good surgical candidates.

Key Points

• A significantly higher spleen volume divided by body surface area was observed in patients who experienced post-hepatectomy liver failure than in patients who did not (148 cm 3 vs. 112 cm 3 , p < 0.001).

• The area under the receiver operating characteristic curve of spleen volume divided by body surface area to predict the development of post-hepatectomy liver failure was 0.663 (p < 0.001).

• Spleen volume divided by body surface area was a significant influencing factor for overall survival (hazard ratio, 3.935; 95% CI, 1.520–10.184; p < 0.001), with the optimal cutoff of 146 cm 3 .

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Abbreviations

AUC:

Area under the curve

HCC:

Hepatocellular carcinoma

HR:

Hepatic resection

HVPG:

Hepatic venous pressure gradient

ICG-R15:

Indocyanine green retention rate at 15 min

OS:

Overall survival

PHLF:

Post-hepatectomy liver failure

ROC:

Receiver operating characteristic

SV:

Spleen volume

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The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    Jae Seok Bae, Dong Ho Lee & Jeongin Yoo

  2. Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    Jae Seok Bae, Dong Ho Lee & Jeongin Yoo

  3. Department of Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    Nam-Joon Yi, Kwang-Woong Lee & Kyung-Suk Suh

  4. Department of Pathology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    Haeryoung Kim & Kyung Bun Lee

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  1. Jae Seok Bae
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Correspondence to Dong Ho Lee.

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The scientific guarantor of this publication is Dong Ho Lee.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

The authors appreciate the Medical Research Collaborating Center at Seoul National University Hospital for their statistical analysis and consultation.

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Bae, J.S., Lee, D.H., Yoo, J. et al. Association between spleen volume and the post-hepatectomy liver failure and overall survival of patients with hepatocellular carcinoma after resection. Eur Radiol 31, 2461–2471 (2021). https://doi.org/10.1007/s00330-020-07313-7

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