The Clinical Significance Of ICG Excretion Test In Preoperative Liver Cancer Patients

Objective:Analysis of ICG excretion test for assessing preoperative hepatic functional reserve and predicting the incidence of postoperative liver dysfunction in liver cancer patients. Evaluating the relativity between the hepatic functional reserve and the incidence of postoperative liver dysfunction in HBV-liver cirrhosis associated with liver cancer. Correlation analysis on ICG excretion test with Child-Pugh classification, MELD score and routine blood biochemical indicators of liver function(CHE, TBIL, INR). Multiple variable linear regression equation was constructed among ICGR15and blood biochemical indicators of liver function, which can provide more convenient and reliable method for evaluation of liver functional reserve. Methods:The clinical data of160cases of liver cancer collected from January to December2011, First Affiliated Hospital of Zhejiang University, were analyzed retrospectively. All the patients underwent preoperative ICG excretion test and surgical treatment, which the primary liver cancer or hepatic metastases were confirmed by pathology. The cases were divided into three groups:Group A HBV-liver cirrhosis associated with liver cancer(60cases), group B HBV infection but non liver cirrhosis associated with liver cancer (61cases), group C liver cancer without HBV infection and liver cirrhosis (39cases). Each group of patients was collected corresponding medical record data (operation mode, ascites, hepatic encephalopathy), HBV markers, preoperative and postoperative blood routine, coagulation function, liver function, renal function, postoperative pathology, liver CT or B examination and ICG excretion test data (ICGR15, K). SPSS17.0for windows was applied to analyze data. The measurement data of normal distribution was expressed with mean±standard deviation (x±S). Normal distribution between the two samples were compared with t test. The non normal distribution data was used rank sum test. Comparison of count data was used chi square test. Correlation analysis of non normal distribution data was used Spearman analysis. Correlation analysis between ICGR15and routine blood biochemical indicators of liver function was used multiple linear regression analysis. P<0.05showed statistical significantly difference.Result:1.160cases of patients included140cases of Child A,18cases of Child B and2cases of Child C (too few, not included in statistics). ICGR15and K value between the two groups were compared by two independent sample rank sum test, and the difference between them was significant(P<0.001).2. The correlation coefficients between ICGR15and MELD score were0.06,0.3and0.43in ICGR15<10%group,10%≥ICGR15<20%group, ICGR15≥20%group. 3. The correlation coefficients between ICGR15and CHE, TBIL, INR were-0.556.0.484,0.345(P<0.001). Using multiple linear regression analysis set up the regression equation ICGR15=31.775-0.528X ALB+0.267X GLB-0.06X ALT-0.001X CHE+0.117X TBA+0.13X GGT.4. The incidence of postoperative liver dysfunction in ICGR15<10%group,10%≤^ICGR15<20%group and ICGR15≥20%group were35.7%,61.7%,82.8%, The differences among the three groups were assessed with chi square test, P<0.001. The differences of ICGR15and K value between liver dysfunction group and non hepatic insufficiency group were examined by rank sum test, which showed significant difference(P<0.001). The difference between1CGR15<25%group and ICGR15≥25%group was assessed with chi square test, which showed significant difference(P=0.008).5. The Difference of ICGR15between HBV-liver cirrhosis associated with liver cancer group and none liver cirrhosis associated with liver cancer group was examined by the independent two-sample t test, P=0.04. The difference of ICGR15between HBV infection associated with liver cancer group and liver cancer without HBV infection and liver cirrhosis group was examined by t" test, P=0.12. The difference of the incidence of postoperative liver dysfunction among different cause of disease were examined by chi square test, and the difference among them was significant(P=0.025). Then used multiple comparison, α’=0.017, the difference of the incidence of postoperative liver dysfunction between HBV-liver cirrhosis associated with liver cancer group and liver cancer without HBV infection and liver cirrhosis group was examined by chi square test, P=0.010<0.017.Conclusion:ICG excretion test was a sensitive index of hepatic functional reserve in patients with liver cancer. ICG excretion test had good correlations with Child-Pugh classification and routine blood biochemical indicators of liver function, so they can be complementary in the evaluation of hepatic functional reserve. For patients with end-stage liver disease, it was a more effective way to combine the ICG excretion test with MELD score for assessing hepatic functional reserve. There was a positive correlation between ICGR15and the incidence of postoperative liver dysfunction, so ICGR15had important guiding significance in predicting the rate of postoperative liver dysfunction. Because of worse hepatic functional reserve and higher incidence of postoperative liver dysfunction in patients with HBV-Iiver cirrhosis associated with liver cancer, it is necessary to make comprehensive evaluation of liver functional reserve before surgery and make individualized treatment programs for reducing the occurrence of postoperative liver dysfunction.