PDF(Pubmed)
Abstract：
OBJECTIVE: Our study aims to evaluate the predictive accuracy of functional liver remnant volume (FLRV) in post-hepatectomy liver failure (PHLF) among surgically-treated jaundiced patients with hilar cholangiocarcinoma (HCCA).
METHODS: We retrospectively reviewed surgically-treated jaundiced patients with HCCA between June, 2000 and June, 2018. The correlation between FRLV and PHLF were analyzed. The optimal cut off value of FLRV in jaundiced HCCA patients was also identified and its impact was furtherly evaluated.
RESULTS: A total of 224 jaundiced HCCA patients who received a standard curative resection (43 patients developed PHLF) were identified. Patients with PHLF shared more aggressive clinic-pathological features and were generally in a more advanced stage than those without PHLF. An obvious inconsistent distribution of FLRV in patients with PHLF and those without PHLF were detected. FLRV (continuous data) had a high predictive accuracy in PHLF. The newly-acquired cut off value (FLRV = 53.5%, sensitivity = 81.22%, specificity = 81.4%) showed a significantly higher predictive accuracy than conventional FLRV cut off value (AUC: 0.81 vs. 0.60, p < 0.05). Moreover, patients with FLRV lower than 53.5% also shared a significantly higher major morbidity rate as well as a worse prognosis, which were not detected for FLRV of 40%.
CONCLUSIONS: For jaundiced patients with HCCA, a modified FLRV of 53.5% is recommended due to its great impact on PHLF, as well as its correlation with postoperative major morbidities as well as overall prognosis, which might help clinicians to stratify patients with different therapeutic regimes and outcomes. Future multi-center studies for training and validation are required for further validation.
METHODS: We retrospectively reviewed surgically-treated jaundiced patients with HCCA between June, 2000 and June, 2018. The correlation between FRLV and PHLF were analyzed. The optimal cut off value of FLRV in jaundiced HCCA patients was also identified and its impact was furtherly evaluated.
RESULTS: A total of 224 jaundiced HCCA patients who received a standard curative resection (43 patients developed PHLF) were identified. Patients with PHLF shared more aggressive clinic-pathological features and were generally in a more advanced stage than those without PHLF. An obvious inconsistent distribution of FLRV in patients with PHLF and those without PHLF were detected. FLRV (continuous data) had a high predictive accuracy in PHLF. The newly-acquired cut off value (FLRV = 53.5%, sensitivity = 81.22%, specificity = 81.4%) showed a significantly higher predictive accuracy than conventional FLRV cut off value (AUC: 0.81 vs. 0.60, p < 0.05). Moreover, patients with FLRV lower than 53.5% also shared a significantly higher major morbidity rate as well as a worse prognosis, which were not detected for FLRV of 40%.
CONCLUSIONS: For jaundiced patients with HCCA, a modified FLRV of 53.5% is recommended due to its great impact on PHLF, as well as its correlation with postoperative major morbidities as well as overall prognosis, which might help clinicians to stratify patients with different therapeutic regimes and outcomes. Future multi-center studies for training and validation are required for further validation.
摘要：
目的：我们的研究旨在评估手术治疗的肝门部胆管癌（HCCA）黄疸患者肝切除术后肝衰竭（PHLF）中功能性肝残量（FLRV）的预测准确性。
方法：我们回顾了6月之间手术治疗的HCCA黄疸患者，2000年和6月,2018.分析FRLV与PHLF的相关性。还确定了黄疸HCCA患者中FLRV的最佳截止值，并进一步评估了其影响。
结果：共有224例接受标准治愈性切除术的HCCA患者（43例患者出现PHLF）被确定。与没有PHLF的患者相比，患有PHLF的患者具有更积极的临床病理特征，并且通常处于更晚期的阶段。发现PHLF患者和无PHLF患者的FLRV分布明显不一致。FLRV（连续数据）在PHLF中具有较高的预测准确性。新获得的截止值(FLRV=53.5%，灵敏度=81.22%，特异性=81.4%）显示出比常规FLRV截断值显著更高的预测准确性(AUC：0.81vs.0.60,p<0.05)。此外，FLRV低于53.5%的患者的主要发病率明显较高，预后较差，未检测到40%的FLRV。
结论：对于患有HCCA的黄疸患者，由于对PHLF的影响很大，建议使用53.5%的改良FLRV，以及其与术后重大疾病和总体预后的相关性，这可能有助于临床医生对具有不同治疗方案和结果的患者进行分层。未来的多中心培训和验证研究需要进一步验证。
方法：我们回顾了6月之间手术治疗的HCCA黄疸患者，2000年和6月,2018.分析FRLV与PHLF的相关性。还确定了黄疸HCCA患者中FLRV的最佳截止值，并进一步评估了其影响。
结果：共有224例接受标准治愈性切除术的HCCA患者（43例患者出现PHLF）被确定。与没有PHLF的患者相比，患有PHLF的患者具有更积极的临床病理特征，并且通常处于更晚期的阶段。发现PHLF患者和无PHLF患者的FLRV分布明显不一致。FLRV（连续数据）在PHLF中具有较高的预测准确性。新获得的截止值(FLRV=53.5%，灵敏度=81.22%，特异性=81.4%）显示出比常规FLRV截断值显著更高的预测准确性(AUC：0.81vs.0.60,p<0.05)。此外，FLRV低于53.5%的患者的主要发病率明显较高，预后较差，未检测到40%的FLRV。
结论：对于患有HCCA的黄疸患者，由于对PHLF的影响很大，建议使用53.5%的改良FLRV，以及其与术后重大疾病和总体预后的相关性，这可能有助于临床医生对具有不同治疗方案和结果的患者进行分层。未来的多中心培训和验证研究需要进一步验证。
