Modello predittivo dell'insufficienza epatica irreversibile dopo resezione epatica per epatocarcinoma su cirrosi: il 'resection score'

Background and aim Liver resection is the one of the curative therapeutic options for Hepatocellular Carcinoma (HCC) on hepatic cirrhosis, with radical intent, and the best results in terms of survival rate and HCC recurrence can be achieved compared to liver transplantation. The risk of postoperative irreversible liver failure, increased by underlying cirrhosis, is one of the principal limits of liver resection. The aim of this study is to obtain a predictive score of irreversible liver failure and early death post-hepatectomy, available for clinic practice in the assessment of HCC patients on cirrhosis that could potentially undergo liver resection. Materials and Methods The study cohort included 367 patients that underwent liver resection for HCC on cirrhosis in the Padua Hepato-biliary Surgery Center from Jan.01, 2000 till Dec. 31,2013. Using uni and multi-variate logistic regression predictive variables of post-hepatectomy irreversible liver failure – early death (within 6 months from resection) were identified in order to build a predictive score; the predictive power of mid- long term survival of the score was tested. We validated the score with another cohort of 343 patients that underwent liver resection for HCC on cirrhosis at the Mount Sinai Institute of New York. Results Early death rate on the study cohort was 10% and 12% in the validation cohort. 1, 3 and 5 years survival rate on study and validation cohort were 82% vs 85%, 57% vs 71%, 45% vs 63%, respectively. At multi-variate logistic regression early death correlate variables were age (p= 0.0021), positivity to hepatitis B (p= 0.0151), sodium level <139 (p= 0.0089), platelets <150000 (p= 0.0002), AFP (p= 0.0011), MELD>8 (p= 0.0026), excessing “up to seven” criteria (p= 0.0016) for neoplastic characteristics. In the study cohort patients that obtained a score >10 had a median survival of 32 months if BCLC A-0 and 42 months if BCLC B-C, versus a median survival of 69 and 42 months in patients wi