| Objective: To inquire the usefulness of preoperative Liver stiffness measurement(LSM)in predicting postoperative liver failure(PLF)after hepatectomy for HBV-related hepatocellular carcinoma(HCC).Methods: In this study,a total of 361 patients with primary hepatocellular carcinoma who underwent hepatectomy were enrolled in this study,including 247 patients in the experimental group and 114 patients in the validation group.All patients were positive for hepatitis B antigen for at least 6 months,and the liver was tested on the day before surgery.All the preoperative and postoperative laboratory indexes and postoperative pathological results were recorded.The influencing factors of postoperative liver failure The factors influencing the outcome of liver failure were analyzed by multivariate analysis of single factor analysis and single factor analysis.The independent factors influencing liver failure were observed in patients with hepatocellular carcinoma after liver resection.(ROC)to understand the diagnostic efficacy,to provide a reference value for the clinical,and based on independent risk factors to build a diagnosis of liver failure model(LFM),and to verify the diagnostic performance.Results: in the experimental group of 247 patients,the mean age of the patients was 53 years.All patients had positive hepatitis B surface antigen and at least 6 months.Among them,79 cases(31%)showed liver cirrhosis according to the postoperative pathological results.According to the definition of hepatic failure,37 cases of hepatic failure after hepatectomy were found in patients with hepatitis B-related hepatocellular carcinoma.The results of single factor and multivariate analysis showed that liver hardness(LSM)and INR were postoperative hepatic failure(OR> 1),and the liver failure prediction model(LFM)was constructed with these two indexes.The area under the ROC curve of the diagnosis of liver failure was 87%(cutoff =-1.92,p <0.001,95% CI0.822-0.909),the sensitivity was 86.49% and the specificity was 74.76%.A total of 114 patients in the validation group had an average age of 53 years,45 patients with cirrhosis,and 14 patients with liver failure.According to the optimal cutoff value obtained from the model in the experimental group,the sensitivity was 85.71%,the specificity was 81%,the positive predictive value was 38.7%,the negative predictive value was 97.65,the correct index was 0.667,Misdiagnosis rate was 19%,false positive rate was 19%,the coincidence rate was 82.6%.LSM in patients with liver failure in the experimental group was significantly higher than that in patients without liver failure.With the increase of LSM in patients with hepatitis B-related hepatocellular carcinoma,the risk of liver failure was greater(the mean LSM of the liver failure group was 21.4 kPa,(P <0.05),and the single factor showed low levels of prealbumin,high levels of γ-glutamyl transpeptidase,prothrombin time(PT),and LSM,intraoperative blood transfusion,liver Sclerosis and esophageal varices of the performance of postoperative liver failure have a certain impact.Conclusions: In summary,the results of this study show that LSM has a good predictive value for postoperative liver failure in patients with hepatitis B-related liver cancer.With the increase of liver LSM in patients with hepatitis B-related hepatocellular carcinoma,it is more likely to cause postoperative liver failure.And LSM on liver cirrhosis also have a certain diagnostic performance.And by LSM combined with INR to build a model of diagnosis of liver failure(LFM)have a certain clinical reference value,which can be used as a preoperative screening of patients with indicators. |
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