Value of spleen stiffness and spleen volume in predicting posthepatectomy liver failure in patients with hepatocellular carcinoma

Objective To investigate the value of spleen stiffness( SS) and spleen volume( SV) in predicting posthepatectomy liver failure( PHLF) in patients with hepatocellular carcinoma( HCC). Methods Related clinical data were collected from the patients with HCC who underwent hepatectomy in Suzhou Ninth People's Hospital and The Third Affiliated Hospital of Second Military Medical University from May2014 to February 2019. SS,liver stiffness( LS),SV,residual remnant liver volume( FRLV),and inflammation markers were measured for all patients before surgery. The independent samples t-test was used for comparison of continuous data between two groups; a Pearson correlation analysis was used to investigate the correlation of SS with LS and SV; univariate and multivariate logistic regression analyses were used to identify the influencing factors for the development of PHLF. The receiver operating characteristic( ROC) curve was used to evaluate the clinical value of SS,SV/FRLV,and hepatic inflow occlusion( HIO),and the area under the ROC curve( AUC),sensitivity,and specificity were calculated. Results A total of 148 patients with HCC were enrolled,among whom 21( 14. 2%) developed PHLF. Postoperative pathology revealed liver cirrhosis in 73 patients( 49. 3%). There were significant differences in SV,LS,and SS between the patients with liver cirrhosis and those without liver cirrhosis( t = 13. 610,6. 952,and 20. 580,all P < 0. 001). The correlation analysis showed that SS was positively correlated with LS and SV( r = 0. 650 and 0. 453,P = 0. 002 and 0. 005). The univariate analysis showed that tumor diameter,liver cirrhosis,neutrophil/lymphocyte ratio,LS,SS,SV/FRLV,time of operation,blood transfusion,and HIO duration were associated with the development of PHLF( all P < 0. 05),and the multivariate logistic regression analysis showed that SV/FRLV( hazard ratio[HR]= 26. 564,95% confidence interval [CI]: 1. 611-422. 541,P < 0. 001),SS( HR = 1. 018,95% CI: 1. 014-1. 154,P =0. 008),and HIO duration( HR = 1. 045,95% CI: 1. 012-1. 084,P = 0. 002) were independent risk factors for PHLF. The ROC curve analysis showed that SV/FRLV had an AUC of 0. 867( 95% CI: 0. 755-0. 926,P < 0. 001),a sensitivity of 0. 783,and a specificity of0. 919 in predicting PHLF; SS had an AUC of 0. 856( 95% CI: 0. 715-0. 984,P < 0. 001),a sensitivity of 0. 673,and a specificity of0. 862 in predicting PHLF; HIO had an AUC of 0. 694( 95% CI: 0. 542-0. 862,P = 0. 003),a sensitivity of 0. 696,and a specificity of0. 741 in predicting PHLC. Conclusion SS and SV/FRLV can help to predict the development of PHLF in patients with HCC.