The Value Of APRI Combined With ICGR15 In Evaluating The Risk Of The Post Hepatectomy Liver Failure For Stage B Primary Hepatocellular Carcinoma In Barcelona Clinical Liver Classification

Background:BCLC staging as a guide to liver cancer diagnosis and treatment is considered to be the best staging system in many countries^[1,2,3,4],and for BCLC-B patients,the system recommends TACE treatment.With the advancement of technology and the evolution of the technology of the surgeon,the treatment plan for liver cancer has gradually improved,and the therapeutic effect has been significantly improved.In the improvement of postoperative survival rate and reduction of postoperative recurrence rate,complete surgical resection is still the best treatment.Multiple data suggest that some patients with BCLC-B stage can achieve similar results after surgery in patients with BCLC-A after complete surgical resection of the tumor^[5].China is a large country with hepatitis virus infection.About 80%of HCC patients have cirrhosis,and most of them are BCLC-B^[6].Compared with normal liver,the liver tissue regeneration ability of patients with cirrhosis is significantly worse,and their liver reserve function is reduced to a different extent.Patients with liver cancer and cirrhosis undergoing liver resection will face greater risks.The main cause of death after hepatectomy is Liver failure,therefore,must pay attention to the evaluation of preoperative liver reserve function.The aspartate aminotransferase/platelet ratio index as a diagnostic indicator for non-invasive cirrhosis^[7]has received increasing attention in the preoperative evaluation of surgical outcomes in patients with liver cancer.In addition,ICGR15 is currently recognized as a more accurate method for preoperative assessment of liver reserve function in dynamic liver function tests^[8-9].Patients with cirrhosis have poor liver regeneration and reduced reserve function.Patients with liver cancer and cirrhosis will face greater risk of liver resection.The main cause of death is liver failure.Therefore,it is necessary to pay attention to the evaluation of preoperative liver reserve function.Objective:Analyze the date of patients with stage B Primary hepatocellular carcinoma in Barcelona Clinical Liver Classification?BCLC-B?,and to explore the value of aspartate transaminase and platelet ratio index?APRI?combined with the indocyanine green retention rate at 15 mins?ICGR15?in evaluating the risk of the posthepatectomy liver failure?PHLF?for BCLC-B.Methods:Analysis of clinical data of 216 patients with BCLC-B hepatocellular carcinoma undergoing hepatectomy.The best cut-off point of APRI value was obtained by ROC curve.the logistic regression model was used to identify independent predictive indices for PHLF.According to whether Postopeatectomy Liver Failure?PHLF?,they were divided into hepatic failure group and non-hepatic failure group.The differences in clinical biochemical parameters,ICGR15 and APRI between the two groups were recorded and analyzed.Result:1.PHLF occurred in 30 of 216 patients with BCLC-B HCC,and the postoperative liver failure rate was 12.9%;2.APRI and ICGR15 were significantly associated with the prognosis of PHLF patients?P<0.001?.The ROC curve analysis showed that APRI had a strong predictive power for PHLF,and the best cut-off point was 0.59.The area under the APRI-ICGR15 combined receiver operating characteristic curve was higher than the APRI or ICGR15 single index.;3.By performing logistic single factor and multivariate regression analysis of PHLF,it was shown that Child-pugh classification,APRI,ALB,PT,ICGR15,intraoperative blood loss,and hepatic occlusion time were considered to affect postoperative BCLC-B HCC patients.Independent risk factors for PHLF.Conclusion:1.APRI and ICGR15 are independent risk factors for postoperative PHLF in patients with BCLC-B HCC;2.The sensitivity and specificity of APRI-ICGR15 for the prediction of PHLF in patients with BCLC-B were higher than their respective predictive powers;3.For patients with BCLC-B stage HCC,when APRI<0.59 and ICGR15<10%,the incidence of liver failure after hepatectomy is low;when APRI?0.59 and ICGR15<10%,or APRI<0.59 and ICGR15?10%at that time,the incidence of PHLF is slightly higher.At this time,surgical treatment should be cautious.Liver function should be actively corrected before operation,and active supportive treatment should be given after surgery.When APRI?0.59 and ICGR15?10%,the incidence of PHLF is higher.Surgical treatment is not recommended for the time being.