Further Study On The Evaluation Of Liver Functional Reserve With ICG Excretion Test

Background&AimsHepatocellular carcinoma(HCC)is one of the most common cancer of human kind,of which the surgery is the most important treatment.Preoperative evaluation of liver functional reserve is vital to decide on the scheme of surgery and predict the prognosis.Indocyanine green(ICG)excretion test is the most widely used quantitative live function test.Past studies have indicated that ICG retention value at 15 min(ICG R15)showed important predictive value on the prognosis of hepatectomy.This study was aimed to investigate the predictive value of ICG retention value at 5 min(ICG R5),ICG retention value at 10 min(ICG R10),ICG retention value at 15 min(ICG R15),ICG serum disappearance rate(ICG K),T1/2,effective hepatic blood flow(EHBF)on post-surgery hospitalization time,post-surgery liver failure and long-term survival after radiofrequency ablation(RFA).MethodsClinical data of 356 HCC patients who underwent ICG excretion test from October 2014 to June 2017 in the Second Affiliated Hospital of Zhejiang University was analysed retrospectively to find out the predictive value of ICG excretion test on liver functional reserve,including post-surgery hospitalization time,post-surgery liver failure and long-term survival after RFA.Multiple linear regression analysis was used to analyze the influencing factors of hospitalization time;binary logistic regression analysis was used to analyze the factors affecting postoperative liver failure;factors affecting long-term survival of patients with RFA were analyzed using Cox proportional hazards regression model;and the receiver operating characteristic curve(ROC)was used to determine the cut-off value of ICG excretion test-related indicators in predicting the occurrence of hepatic failure after surgery,and area under the curve(AUC)was used to compare with end-stage liver disease(MELD)score and albumin-bilirubin grade(ALBI)score.Survival analysis was performed using the Kaplan-Meier method to plot the recurrence-free survival(RFS)and overall survival(OS)curves.Log-rank was used to examine the differences between groups.ResultsOf the 356 HCC patients,196 underwent RFA,92 underwent hepatectomy,12 underwent transcatheter arterial chemoembolization(TACE),and the remaining 56 patients gave up surgery.The follow-up time of 196 patients with RFA was 8-30 months,and the median follow-up time was 16 months,during which 6 patients were lost to follow-up.ICG R5,ICG RIO,ICG R15,ICG K,T1/2 and EHBF related to ICG excretion tests were significantly associated with liver function serum biochemical markers.ICG R5,ICG R10,ICG R15,and T1/2 in the Child-Pugh grade A patients were significantly lower than grade B patients,and the ICG K and EHBF were significantly higher than grade B patients.All of them were significantly associated with the MELD and ALBI classifications.The six parameters were also significantly correlated with each other,showing a strong collinear relationship.However,multiple linear regression analysis showed that ICG excretion test-related indicators were not independent risk factors for postoperative hospitalization time.In predicting postoperative liver failure in patients undergoing RFA,ICG R15 had the highest AUC of 0.183,which was not significantly different from the remaining 5,but was significantly higher than the MELD score(p<0.001)and ALBI score(p=0.013).The cut-off value was 12.0%,where the sensitivity and specificity were 90.5%and 61%,respectively.In predicting postoperative hepatic failure in patients undergoing hepatectomy,ICG R15 had the highest AUC of 0.718,which was also not significantly different from the remaining 5,but was significantly higher than the MELD score(p<0.001)and ALBI score(p=0.003).The cut-off value was 6.45%and the sensitivity and specificity were 68.8%and 65.9%,respectively.ICG excretion test-related indicators were also independent risk factors for survival rate after RFA and can predict RFS and OS.ConclusionsICG R5,ICG R10,ICG R15,ICG K,T1/2 and EHBF of preoperative ICG excretion test in patients with hepatocellular carcinoma were significantly associated with serum markers of hepatic function,and correlated with Child-Pugh,MELD,and ALBI score.ICG R5,ICG R10,ICG R15,ICG K,T1/2 and EHBF shared such high collinearity among each other that there was no significant difference in the accuracy of predicting hepatic failure in patients who underwent either RFA or hepatectomy.But they had significantly higher accuracy than MELD score and ALBI score.In addition,they can also predict the long-term survival after RFA.