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Volumetric assessment and clinical predictors of cirrhosis in patients undergoing hepatectomy for hepatocellular carcinoma with presumed normal liver function

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Abstract

Aim

Indocyanine green retention rate at 15 min (ICGR15) is a frequently used indicator of liver function. Herein, clinicopathological characteristics of cirrhotic patients with normal ICGR15 value (< 10%) were investigated, as these patients have risk of postoperative liver insufficiency when receiving a major hepatic resection.

Methods

Patients undergoing hepatectomy for hepatocellular carcinoma were divided into three groups: non-cirrhotic livers (Group A, n = 112): cirrhotic livers with ICGR15 < 10% (Group B, n = 71): and cirrhotic livers with ICGR15 > 10% (Group C, n = 296). Background characteristics and surgical outcomes were compared between groups. Functional liver volume (FLV) was computed using total liver volume and signal intensity ratio. Liver parenchymal cell volume ratio was measured in non-cancerous tissue obtained from resected specimens. Univariate and multivariate analyses were performed to detect clinical characteristics correlating with cirrhotic liver pathology with normal ICGR15.

Results

There was no significant difference between groups in TLV. FLV was gradually reduced from Group A toward Group C. Liver parenchymal cell volume ratio was also gradually reduced from Group A toward Group C. Multivariate analysis revealed that platelet count (< 12 × 104/mm3) (p = 0.001) and prothrombin time (< 80%) (p = 0.025) were significantly associated with cirrhotic liver pathology among patients with normal ICGR15.

Conclusion

Our results suggested that cirrhotic liver pathology despite normal liver function was characterized by slightly decreasing liver parenchyma as well as slight degree of fibrosis. Platelet count and PT% are useful for predicting liver cirrhosis with normal ICGR15.

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Availability of data and materials

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Code availability

Not applicable.

Abbreviations

ARPI:

Aspartate aminotransferase-to-platelet ratio index

FIB-4:

Fibrosis-4

FLV:

Functional liver volume

Gd-EOB-DTPA:

Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid

HCC:

Hepatocellular carcinoma

ICG:

Indocyanine green

ICGR15:

Indocyanine green retention rate at 15 min

PT%:

Prothrombin time percentage

SI:

Signal intensity

TLV:

Total liver volume

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Funding

We received no funding/grant support for this study.

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Authors and Affiliations

  1. Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan

    Takayuki Shimizu, Taku Aoki, Kyung-Hwa Park, Takatsugu Matsumoto, Takayuki Shiraki, Yuhki Sakuraoka, Shozo Mori, Yukihiro Iso, Mitsuru Ishizuka & Keiichi Kubota

Authors
  1. Takayuki Shimizu
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  2. Taku Aoki
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  3. Kyung-Hwa Park
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  4. Takatsugu Matsumoto
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Contributions

Study concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, and statistical analysis: TS; study concept and design, acquisition of data, analysis and interpretation of data, and critical revision of the manuscript for important intellectual content: TA; study concept and design, and critical revision of the manuscript for important intellectual content: KK; acquisition of data: YN, KHP, TM, TS, YS, SM, and YI; statistical analysis: MI. All authors approved the final version of manuscript.

Corresponding author

Correspondence to Taku Aoki.

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Conflict of interest

Takayuki Shimizu, Taku Aoki, Kyung‑Hwa Park, Takatsugu Matsumoto, Takayuki Shiraki, Yuhki Sakuraoka,·Shozo Mori, Yukihiro Iso, Mitsuru Ishizuka, Keiichi Kubotas declare no conflict of interests for this article.

Ethical approval

Our study was approved by the Institutional Review Board (provided ID number: R-8-14) on the basis of the Ethical Guidelines for Clinical Research of the Ministry of Health, Labor and Welfare in Japan prior to its initiation.

Consent to participate

We provided the enrolled patients with the opportunity to opt out on our website www2.dokkyomed.ac.jp/dep-m/surg2/pg334.html().

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Not applicable.

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Shimizu, T., Aoki, T., Park, KH. et al. Volumetric assessment and clinical predictors of cirrhosis in patients undergoing hepatectomy for hepatocellular carcinoma with presumed normal liver function. Hepatol Int 15, 1258–1267 (2021). https://doi.org/10.1007/s12072-021-10246-y

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