Low Functional Liver Imaging Score is Associated with Poor Prognosis Following Hepatectomy for Hepatocellular Carcinoma

Overview

Journal Sci Rep

Specialty Science

Date 2024 Dec 29

PMID 39732922

Authors

Nozomu Sakai

Tsukasa Takayashiki

Shigetsugu Takano

Daisuke Suzuki

Masayuki Ohtsuka

Affiliations

Soon will be listed here.

Abstract

Liver function affects the prognosis of patients with hepatocellular carcinoma (HCC). This study aimed to investigate the prognostic impact of the functional liver imaging score (FLIS), assessed using gadoxetic acid-enhanced magnetic resonance imaging, on long-term outcomes following hepatectomy for HCC. The FLIS was assessed in 235 patients who underwent initial hepatectomy for HCC. The relationship between FLIS and prognosis was retrospectively analyzed. The FLIS was 6 in 185, and 2-5 in 50, patients. The 5-year recurrence-free and overall survival rates were 43.6% and 76.4% in patients with an FLIS of 6, and 23.0% and 42.4% in patients with an FLIS of 2-5, respectively; both recurrence-free and overall survival were significantly better in patients with an FLIS of 6 (P = 0.012 and 0.001, respectively). Multivariable analyses revealed that microvascular invasion (hazard ratio: 3.611; P = 0.002) and an FLIS of 2-5 (hazard ratio: 2.558; P = 0.027) were independently associated with shorter overall survival. After propensity-score matching, overall survival was significantly better in patients with an FLIS of 6. A low FLIS was significantly associated with poor prognosis following initial hepatectomy for HCC, suggesting that surgical indications must be carefully considered in patients with a low FLIS.

References

Aslan S, Eryuruk U, Tasdemir M, Cakir I . Determining the efficacy of functional liver imaging score (FLIS) obtained from gadoxetic acid-enhanced MRI in patients with chronic liver disease and liver cirrhosis: the relationship between Albumin-Bilirubin (ALBI) grade and FLIS. Abdom Radiol (NY). 2022; 47(7):2325-2334. DOI: 10.1007/s00261-022-03557-7. View

Hiraoka A, Kumada T, Kudo M, Hirooka M, Tsuji K, Itobayashi E . Albumin-Bilirubin (ALBI) Grade as Part of the Evidence-Based Clinical Practice Guideline for HCC of the Japan Society of Hepatology: A Comparison with the Liver Damage and Child-Pugh Classifications. Liver Cancer. 2017; 6(3):204-215. PMC: 5473065. DOI: 10.1159/000452846. View

Lee H, Hong S, Lee N, Kim S, Seo H, Kim D . Validation of functional liver imaging scores (FLIS) derived from gadoxetic acid-enhanced MRI in patients with chronic liver disease and liver cirrhosis: the relationship between Child-Pugh score and FLIS. Eur Radiol. 2021; 31(11):8606-8614. DOI: 10.1007/s00330-021-07955-1. View

Luo N, Huang X, Ji Y, Jin G, Qin Y, Xiang B . A functional liver imaging score for preoperative prediction of liver failure after hepatocellular carcinoma resection. Eur Radiol. 2022; 32(8):5623-5632. DOI: 10.1007/s00330-022-08656-z. View

Kelley R, Ueno M, Yoo C, Finn R, Furuse J, Ren Z . Pembrolizumab in combination with gemcitabine and cisplatin compared with gemcitabine and cisplatin alone for patients with advanced biliary tract cancer (KEYNOTE-966): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2023; 401(10391):1853-1865. DOI: 10.1016/S0140-6736(23)00727-4. View

Qiao P, Li L, Ruan H, Zhang M, Wang Z, Li X . Application of the ALBI Scoring System for Mortality Outcome Prediction in Patients with Hypertrophic Cardiomyopathy. Glob Heart. 2022; 17(1):73. PMC: 9562974. DOI: 10.5334/gh.1163. View

Bastati N, Beer L, Mandorfer M, Poetter-Lang S, Tamandl D, Bican Y . Does the Functional Liver Imaging Score Derived from Gadoxetic Acid-enhanced MRI Predict Outcomes in Chronic Liver Disease?. Radiology. 2019; 294(1):98-107. DOI: 10.1148/radiol.2019190734. View

Toyoda H, Kumada T, Kaneoka Y, Osaki Y, Kimura T, Arimoto A . Prognostic value of pretreatment levels of tumor markers for hepatocellular carcinoma on survival after curative treatment of patients with HCC. J Hepatol. 2008; 49(2):223-32. DOI: 10.1016/j.jhep.2008.04.013. View

Sasaki K, Shindoh J, Margonis G, Nishioka Y, Andreatos N, Sekine A . Effect of Background Liver Cirrhosis on Outcomes of Hepatectomy for Hepatocellular Carcinoma. JAMA Surg. 2017; 152(3):e165059. DOI: 10.1001/jamasurg.2016.5059. View

10.

Na S, Yim S, Suh S, Jung Y, Kim J, Seo Y . ALBI versus Child-Pugh grading systems for liver function in patients with hepatocellular carcinoma. J Surg Oncol. 2018; 117(5):912-921. DOI: 10.1002/jso.24992. View

11.

Zhu Q, Chen D, Lou Y, Xie X, Wu Y, Wang Z . Baseline ALBI Grade Predicts Benefits After Splenectomy for Cirrhotic Patients with Hypersplenism. J Gastrointest Surg. 2023; 27(6):1130-1140. PMC: 10267274. DOI: 10.1007/s11605-023-05610-2. View

12.

Chin K, Koh Y, Syn N, Teo J, Goh B, Cheow P . Early Prediction of Post-hepatectomy Liver Failure in Patients Undergoing Major Hepatectomy Using a PHLF Prognostic Nomogram. World J Surg. 2020; 44(12):4197-4206. DOI: 10.1007/s00268-020-05713-w. View

13.

Bastati N, Beer L, Ba-Ssalamah A, Poetter-Lang S, Ambros R, Kristic A . Gadoxetic acid-enhanced MRI-derived functional liver imaging score (FLIS) and spleen diameter predict outcomes in ACLD. J Hepatol. 2022; 77(4):1005-1013. DOI: 10.1016/j.jhep.2022.04.032. View

14.

Ivanics T, Murillo Perez C, Claasen M, Patel M, Morgenshtern G, Erdman L . Dynamic risk profiling of HCC recurrence after curative intent liver resection. Hepatology. 2022; 76(5):1291-1301. DOI: 10.1002/hep.32411. View

15.

Taketomi A . Hepatic Resection for Hepatocellular Carcinoma in the Era of Molecular-targeted Agents and Immune Checkpoint Inhibitors in Japan. JMA J. 2021; 4(3):241-245. PMC: 8355680. DOI: 10.31662/jmaj.2021-0035. View

16.

Miki A, Sakuma Y, Watanabe J, Endo K, Sasanuma H, Teratani T . Remnant liver function is associated with long-term survival in patients with hepatocellular carcinoma undergoing hepatectomy. Sci Rep. 2023; 13(1):15637. PMC: 10511401. DOI: 10.1038/s41598-023-42929-x. View

17.

Peng Y, Qi X, Tang S, Deng H, Li J, Ning Z . Child-Pugh, MELD, and ALBI scores for predicting the in-hospital mortality in cirrhotic patients with acute-on-chronic liver failure. Expert Rev Gastroenterol Hepatol. 2016; 10(8):971-80. DOI: 10.1080/17474124.2016.1177788. View

18.

Johnson P, Berhane S, Kagebayashi C, Satomura S, Teng M, Reeves H . Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach-the ALBI grade. J Clin Oncol. 2014; 33(6):550-8. PMC: 4322258. DOI: 10.1200/JCO.2014.57.9151. View

19.

Ito T, Nguyen M . Perspectives on the Underlying Etiology of HCC and Its Effects on Treatment Outcomes. J Hepatocell Carcinoma. 2023; 10:413-428. PMC: 10013586. DOI: 10.2147/JHC.S347959. View

20.

Zhou P, Chen B, Miao X, Zhou J, Xiong L, Wen Y . Comparison of FIB-4 Index and Child-Pugh Score in Predicting the Outcome of Hepatic Resection for Hepatocellular Carcinoma. J Gastrointest Surg. 2019; 24(4):823-831. DOI: 10.1007/s11605-019-04123-1. View