Value Of Five Scoring Systems For Predicting Liver Dysfunction After Interventional Treatment Of Liver Cancer

Objective:To investigate the related factors that affect the occurrence of liver dysfunction in the early stage of liver cancer after transcatheter arterial chemoembolization(TACE)or radio frequency ablation(RPA)treatment,and compare(Child-Turcotte-Pugh(CTP))score,final End-stage liver disease model MELD,MELD-ICG score of end-stage liver disease model combined with indocyanine green clearance test,chronic liver dysfunction(CLD)score,modified albumin-bilirubin(ALBI)The scores are mALBI scores,and the five kinds of scores are predictive value of liver dysfunction in patients with primary liver cancer after TACE or RAF treatment.Methods:From June 2017 to December 2019,113 cases of primary liver cancer with complete admission data and interventional treatment were selected,of which 87 patients were treated with TACE and 26 patients were treated with RFA.(1)Retrospective analysis of the clinical data of patients with primary liyer cancer who were treated with TACE(n=87)or RFA(n=26),and divided into liver dysfunction group and liver function In the compensation group,the clinical characteristics of the two groups were analyzed respectively.The t-test was used for comparison between the measurement data of the measurement data that met the normal distribution;the Mann-Whitney U test was used for comparison between the groups that did not meet the normal distribution.Chi-square test was used to compare the count data between groups(P<0.05 indicates that the difference is statistically significant).(2)The results of P<0.005 in the univariate analysis were selected to introduce a logistic regression model for further analysis,and independent risk factors for liver dysfunction after interventional treatment were selected.(3)spearman correlation analysis was used to compare the correlation of the five scoring systems of CTP,MELD,MELD-ICG,CLD,and mALBI scores;MedCalc 15.1 statistical software was used to draw the subjects of the five scores in TACE or RFA cases Working characteristic curve(ROC curve),which calculates the sensitivity.specificity,Jordan index,95%CI,standard error,and uses the corresponding value at the time of the approximate index as the cutoff value,and selects the cutoff value of the optimal score.The area under the ROC curve of the five scores was compared using the Z test,and the superiority between the five scores was compared to select the best predictive scoring system.Results:1.113 patients with interventional treatment 27 of the 87 patients with TACE(31.0%)had early postoperative liver dysfunction;8 of the 26 patients with RFA(30.8%)had postoperative liver dysfunction.2.Preoperative BMI,PLT,PAB,TBIL,DBIL,ALP,PT,PTA,INR,ICG-R15,ICG half-life,CTP,MELD,MELD-ICG,The CLD and mALBI scores are statistically different(P<0.05),and the other indicators are not statistically significant(P>0.05);3.Preoperative PLT,PAB,ALB,TBIL,DBIL,ALT,AST,AFP,ICG-R15,ICG half-life,ICGK,EHBF,MELD,MELD-ICG,The differences in CLD and mALBI scores are statistically significant(P<0.05);4.The results of univariate analysis P<0.005 in the TACE treatment group and RFA treatment group were included in Logistic regression,ICG-T1/2(P=0.049)is an independent risk factor for early liver dysfunction after TACE;no exact independent risk factor for early liver dysfunction after RFA5.TACE treated cases can be obtained by drawing ROC curves of five scores:the areas under the ROC curves of preoperative CTP,MELD,MELD-ICG,CLD,and mALBI scores are:0.708,0.787,0.827.0.735,0.723,of which MELDI-The area under the ICG score curve is the largest;6.RFA treated cases can be obtained by plotting five ROC curves:the area under the ROC curve of preoperative CTP,MELD,MELD-ICG,and CLDmALBI scores are:0.747,0.837,0.882,0.851,0.826,of which MELD-ICG The area under the scoring curve is the largest;7.Comparison of the area under the ROC curve of the five scores:the speraman correlation analysis showed that the five scores had a good correlation;the MELD-ICG in the TACE-treated cases predicted AUC of postoperative liver dysfunction was 0.827(95%CI:0.730?0.899)significantly higher than CTP[0.708(95%CI:0.630?0.824),P<0.05]or CLD[0.735(95%CI:0.630?0.824).P<0.05]or mALBI[0.723(95%CI:0.616?0.813),P<0.05],there is no statistically significant difference in the remaining scores(all P values>0.05);there is no statistically significant difference between the five scores in RFA cases,that is,five score systems The predictive ability of hepatic dysfunction after RFA is similar(P>0.05).Conclusion:1.Liver insufficiency is a common complication after TACE or RFA treatment of liver cancer,and its incidence is about 31.0%.2.ICG half-life are independent risk factors for liver dysfunction after TACE.3.CTP,MELD,MELD-ICG,CLD,and mALBI five scoring systems are all effective prediction systems for early liver dysfunction in patients with primary liver cancer after intervention including TACE or RFA.4.The five scoring systems are similar in predicting early liver dysfunction after RFA.5.The predictive value of MELD-ICG to judge early liver dysfunction after TACE in five scoring systems is significantly better than CTP?CLD?mALBI Comprehensive scoring system.MELD-ICG score is recommended as an effective tool to predict liver dysfunction after TACE.6.When the MELD-ICG is greater than 22.0,the MELD-ICG score is highly sensitive and specific for predicting liver dysfunction after TACE.