Clinical Value Of Different Scoring Systems In The Perioperative Risk Assessment Of Patients With HCC Undergoing Laparoscopic Hepatectomy

Objective:To explore the influencing factors of liver insufficiency after laparoscopic hepatectomy（LH）in patients with hepatocellular carcinoma（HCC）,and compare the clinical value of Child-Pugh classification score,model for end-stage liver disease（MELD）and albumin-bilirubin score（ALBI score）in perioperative risk assessment of HCC patients who underwent LH.Methods:The Liver Cancer Database of the Second Department of Hepatopancreatobiliary Surgery of the First hospital of Jilin University was reviewed,85 patients whose pathological findings were confirmed to be HCC from January 2020 to September 2021were selected based on the inclusion and exclusion criteria.The clinical data of 85patients were retrospectively analyzed,and the Child-Pugh classification score,MELD score and ALBI score of each patient were calculated before operation.According to the recovery of liver function after operation,the patients were divided into liver function compensation group and liver insufficiency group,and the clinical data of the two groups were analyzed,including general conditions,laboratory examinations,imaging data,surgical data,pathological data,Indocyanine green test results,etc.Using single factors and multiple factors to analyze the indicators related to the occurrence of postoperative liver insufficiency,and analyzing the correlation between the three scores and the occurrence of postoperative liver dysfunction,then selecting the most clinically valuable score by comparing the Child-Pugh classification score,MELD score and ALBI score of the two groups.Results:Among the 85 patients included in the study,30 patients（35.3%）had postoperative liver dysfunction.Univariate analysis between the two groups revealed that the age,gender,portal hypertension（with/without）,hepatitis（with/without）,maximum diameter of tumor,vascular invasion（with/without）,tumor thrombus（with/without）,intraoperative portal occlusion（yes/no）,Na⁺,Cr,AFP,ALT,AST,GGT,ALP,IBIL,HBG,TT,APTT are not statistically significant（P>0.05）,while the BMI,tumor number,operation time,ALB,TBIL,DBIL,PLT,PT,INR,ICGK,ICGR15,ICGT1/2,EHBF,Child-Pugh classification score,MELD score and ALBI score are statistically significant（P<0.05）.And the BMI,tumor number,operation time,TBIL,DBIL,PT,INR,ICGR15,ICGT1/2,Child-Pugh classification score,MELD score and ALBI score in the liver function compensation group were lower than those in the liver function insufficiency group,while ALB,PLT,ICGK and EHBF were higher than those in the liver function insufficiency group.Further multivariate analysis showed that BMI,operation time and ICGR15 were independent risk factors for liver dysfunction in patients with HCC after LH.By plotting ROC curves of the three scoring systems,the AUC of Child-Pugh classification score,MELD score,and ALBI score are0.730,0.762,and 0.902,respectively,of which the AUC of ALBI score is the largest.Comparing the areas under the ROC curves of the three scoring systems to analyze the predictive diagnostic efficacy of the three scoring systems for hepatic dysfunction,the AUC of ALBI score was 0.902（95%CI:0.834-0.970）,which was significantly higher than that of the Child-Pugh classification score[0.730（95%CI:0.609-0.851）,P<0.05]or MELD score[0.762（95%CI:0.648-0.876）,P<0.05],and the optimal cut-off value of ALBI score was concluded to be≥-2.67,That means,ALBI score≥-2.67 had high sensitivity（80.00%）and specificity（89.09%）for predicting the occurrence of liver dysfunction,while there was no significant difference between Child-Pugh classification score and MELD score（P>0.05）.Conclusions:1.Liver insufficiency is a common complication of HCC patients undergoing LH surgery,and its incidence is about 35.3%.2.BMI,operation time and ICGR15 are independent risk factors for the occurrence of liver insufficiency in HCC patients after LH.3.All three scoring systems,the Child-Pugh classification score,MELD score and ALBI score,can more accurately predict the occurrence of liver insufficiency in HCC patients undergoing LH surgery,but the clinical predictive value of ALBI score is optimal and significantly higher than Child-Pugh classification score and MELD score,and when ALBI score≥-2.67,ALBI score has high sensitivity and specificity for predicting the occurrence of liver insufficiency in HCC patients after LH surgery.Therefore,for HCC patients who will receive LH treatment,it can be the ALBI score used as a tool to predict the occurrence of postoperative liver insufficiency,thereby judging the magnitude of the patient’s perioperative risk.