Wang et al reported a model with nomogram for predicting post-hepatectomy liver dysfunction or failure following resection of a hepatocellular carcinoma (HCC). This can help to identify a patient who may benefit from more aggressive management. The authros are from Guangxi Medical University, Peking Univresity of Oncology, Beijing Cancer Hospital, and Ministry of Education in Nanning, China.
Patient selection: preoperative assessment prior to resection of a hepatocellular carcinoma
Parameters:
(1) serum total bilirubin in µmol/L
(2) serum albumin in g/L
(3) serum GGT in U/L
(4) PT in seconds, relative to normal
(5) clinically significant portal hypertension (CSPH)
(6) planned extent of the resection
points for total bilirubin =
= MIN(2 * (serum bilirubin),100)
points for serum albumin =
= MAX(0,MIN(127.08333 - (2.54167 * (albumin)),61))
points for serum GGT=
= MIN((0.1944 * (GGT)),48.6)
delta PT =
= (patient's PT) - (normal PT)
points for PT =
= MAX(0,MIN((7.45*(delta PT))+22.35,44.7))
Parameter
|
Finding
|
Points
|
CSPH
|
no
|
0
|
|
yes
|
57.25
|
planned resection
|
minor
|
0
|
|
major
|
49.7
|
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 361.25
• The higher the score the greater the risk of post-hepatectomy liver dysfunction or failure.
X = (0.03646 * X) - 6.916
probability of liver dysfunction or failure after hepatectomy =
= 1 / (1 + EXP((-1) * X))