Impact Of Histological Severity Of Cirrhosis On The Safety And Long-term Outcomes Of Hepatectomy For Hepatocellular Carcinoma

Hepatocellular carcinoma(HCC)is a common malignant tumor in the world,and hepatectomy is still the preferred treatment for patients with HCC.Most HCC patients are accompanied by varying degrees of cirrhosis.Collagen proportionate area(CPA)measurement can quantitatively determine the collagen contents of liver tissue.This study performed the CPA measurement using digital image analysis of resected liver tissues stained with Masson trichrome and further explored the impact of CPA on posthepatectomy liver failure(PHLF).Although all patients had Child-Pugh grade A liver function,their CPA values significantly varied and ranged from 1.6% to 42.8%.Multivariate analysis showed that CPA was one of the independent risk factors for PHLF.Besides,the incidence of PHLF increased with increasing CPA stages.Through further analysis of the correlation between CPA and cirrhotic severity scoring(CSS)proposed by our previous research,we demonstrated that CSS was a useful non-invasive method in evaluating cirrhotic severity preoperatively and could be used for the safety assessment of hepatectomy for HCC.Indocyanine green retention rate at 15 min(ICG-R15)is a widely used method in the preoperative assessment of hepatic functional reserve.Our results revealed that histological severity of cirrhosis(Laennec staging system)was not significantly correlated with ICG-R15 in HCC patients with Child-Pugh grade A liver function.Therefore,when evaluating the safety of hepatectomy for HCC,ICG-R15 can not replace the assessment of cirrhotic severity.Compared with ICG-R15,CSS was more effectively in evaluating cirrhotic severity.We further investigated the impact of histological severity of cirrhosis(Laennec staging system)on the long-term outcomes of hepatectomy for HCC and found that the recurrence-free survival(RFS)and overall survival(OS)rates significantly decreased with the increasing severity of cirrhosis.Multivariate analysis showed that histological severity of cirrhosis was one of the independent risk factors for RFS and OS.We further developed novel nomograms that included histological severity of cirrhosis.Novel nomograms could accurately predict postoperative recurrence and long-term survival,which could help surgeons to adopt a close postoperative surveillance plan and adjuvant therapy for those patients with a high risk of tumor recurrence.In summary,our results clearly demonstrated the impact of histological severity of cirrhosis on the safety and long-term outcomes of hepatectomy for HCC.Therefore,paying attention to cirrhotic severity can help surgeons make more scientific and reasonable surgical strategy for HCC.