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Fibroscan and FIB-4 Assessment Versus Lymphocyte / Monocyte Ratio as Predictors of Post-Hepatectomy Liver Failure in HCV Egyptian Patients with Hepatocellular Carcinoma

Received: 20 October 2020     Accepted: 10 November 2020     Published: 24 November 2020
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Abstract

Background: Post-hepatectomy liver failure (PHLF) is the most leading cause of mortality in patients diagnosed with hepatocellular carcinoma (HCC) and undergoing resection of the affected part of the liver. Objectives: This research aimed to determine the value of the lymphocyte to monocyte ratio (LMR), fibrosis score 4 (FIB-4) and liver stiffness measurements (LSM) using Fibroscan as pre-operative predictors of PHLF in Egyptian patients with post- hepatitis C virus (HCV) liver cirrhosis and HCC. Methods: In this prospective cohort study definition of PHLF was done according to the “50-50 criteria”. Multivariate analysis was done to identify PHLF independent predictors. The predictive accuracy of the pre-operative LMR, FIB-4 and LSM with Fibroscan were evaluated by receiver operating characteristic (ROC) curve. Results: Enrollment of fifty Egyptian patients was done. 14 patients (28%) experienced PHLF. The presence of oesophageal varices, serum AST, serum albumin, LMR, FIB-4 score, and LSM (P<0.05) were independent pre-operative predictors for PHLF. According to ROC curve analysis, LMR yielded the best accuracy for predicting PHLF at cutoff <3.33 [AUC = 0.940; sensitivity = 93.65%; specificity = 94.44%; positive predictive value = 86.67%; negative predictive value = 97.14%]. FIB-4 score and LSM had lower AUC (0.886 and 0.875) respectively. Conclusion: The pre-operative LMR has a higher predictive ability for PHLF in patients with HCV-related HCC undergoing hepatectomy compared with FIB-4 score and LSM using Fibroscan.

Published in International Journal of Medical Imaging (Volume 8, Issue 4)
DOI 10.11648/j.ijmi.20200804.15
Page(s) 93-101
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2020. Published by Science Publishing Group

Keywords

Hepatocellular Carcinoma, Resection, Post-hepatectomy Liver Failure, Lymphocyte to Monocyte Ratio, Fibroscan, Fibrosis Score 4

References
[1] Holah, N. S, El-Azab, D. S., Aiad, H. A., Sweed, D. M (2015) Hepatocellular carcinoma in Egypt: epidemiological and histopathological properties, Menoufia Medical Journal, 28: 718-724.
[2] McCormack, L., Petrowsky, H., Jochum, W., Furrer, K., Clavien, P. A (2007) Hepatic steatosis is a risk factor for post-operative complications after major hepatectomy: a matched case-control study, Annals of surgery, 245: 923-930.
[3] Hong, G., Suh, K. S., Suh, S. W., Yoo, T., Kim, H., et al. (2016) Alpha-fetoprotein and 18F-FDG positron emission tomography predict tumor recurrence better than Milan criteria in living donor liver transplantation. Journal of hepatology, 64: 852-859.
[4] Vitale, A., Burra, P., Frigo, A. C, Trevisani, F., Farinati, F., et al. (2015) Survival benefit of liver resection for patients with hepatocellular carcinoma across different Barcelona Clinic Liver Cancer stages: a multicentre study. Journal of hepatology, 62: 617-624.
[5] Wang, Y. Y, Zhong, J. H., Su, Z. Y, Huang, J. E, Lu, S. D, et al. (2016) Albumin–bilirubin versus Child– Pugh score as a predictor of outcome after liver resection for hepatocellular carcinoma. British Journal of Surgery, 103: 725-734.
[6] Berasain, C., Castillo, J., Perugorria, M. J., Latasa, M. U., Prieto, J., (2009) Inflammation and liver cancer: new molecular links. Ann N Y Acad Sci, 1155: 206-221.
[7] Ozawa, T., Ishihara, S., Kawai, K., Kazama, S., Yamaguchi, H., et al. (2015) Impact of a lymphocyte to monocyte ratio in stage IV colorectal cancer. J Surg Res, 199: 386–392.
[8] Wu, S. J, Lin, Y. X, Ye, H., Li, F. Y, Xiong, X. Z, et al. (2016) Lymphocyte to monocyte ratio and prognostic nutritional index predict survival outcomes of hepatitis B virus-associated hepatocellular carcinoma patients after curative hepatectomy. Journal of surgical oncology, 114: 202-210.
[9] Xiao, G., Yang, J. and Yan, L. (2015) Comparison of diagnostic accuracy of aspartate aminotransferase to platelet ratio index and fibrosis-4 index for detecting liver fibrosis in adult patients with chronic hepatitis B virus infection: a systemic review and meta-analysis. Hepatology, 61: 292–302.
[10] Zhang, E., Zhang, Z. Y., Wang, S. P., Xiao, Z. Y., Gu, J., et al. (2016) Predicting the severity of liver cirrhosis through clinical parameters. J Surg Res, 204: 274–281
[11] Dong, J., Xu, X. H, Ke, M. M, Xiang, J. X, Liu, W. Y, et al. (2016) The FIB-4 score predicts post-operative short-term outcomes of hepatocellular carcinoma fulfilling the milan criteria. European Journal of Surgical Oncology (EJSO), 42: 722-727.
[12] Sandrin, L., Fourquet, B., Hasquenoph, J. M., Yon, S., Fournier, C., et al. (2003) Transient elastography: a new noninvasive method for assessment of hepatic fibrosis. Ultrasound Med Biol, 29: 1705–1713.
[13] Cescon, M., Colecchia, A., Cucchetti, A., Peri, E., Montrone, L., et al. (2012) Value of transient elastography measured with fibroscan in predicting the outcome of hepatic resection for hepatocellular carcinoma. Ann. Surg, 256: 706–712.
[14] Vauthey, J. N, Dixon, E., Abdalla, E. K., Helton, W. S., Pawlik, T. M, et al. (2010) Pretreatment assessment of hepatocellular carcinoma: expert consensus statement. Hepato-Pancreato-Biliary Association, 12: 289-299.
[15] Forner, A., Llovet, J. M, and Bruix, J. (2012) Hepatocellular carcinoma. Lancet, 379: 1245–1255.
[16] Berzigotti, A., Reig, M., Abraldes, J. G, Bosch, J., and Bruix, J. (2015) Portal hypertension and the outcome of surgery for hepatocellular carcinoma in compensated cirrhosis: a systematic review and meta-analysis. Hepatology, 61: 526-536.
[17] Balzan, S., Belghiti, J., Farges, O., Ogata, S., Sauvanet, A., Delefosse, D., et al. (2005) The “50-50 criteria” on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy. Ann Surg, 242: 824–828, discussion 828–829.
[18] Neofytou, K., Smyth, E. C., Giakoustidis, A., Khan, A. Z, Williams, R., et al. (2015) The pre-operative lymphocyte-to-monocyte ratio is prognostic of clinical outcomes for patients with liver-only colorectal metastases in the neoadjuvant setting. Annals of surgical oncology, 22: 4353-4362.
[19] Suh, B., Park, S., Shin, D. W., Yun, J. M, Yang, H. K, et al. (2015) High liver fibrosis index FIB-4 is highly predictive of hepatocellular carcinoma in chronic hepatitis B carriers. Hepatology, 61: 1261-1268.
[20] S irli, R., Sporea, I., Bota, S., et al. (2013) Factors influencing reliability of liver stiffness measurements using transient elastography (M-probe)- monocentric experience. Eur J Radiol, 82 (8): e313-6.
[21] Dun, G. P, Old, L. J, and Schreiber, R. D. (2004) The immunobiology of cancer immunosurveillance and immunoediting. Immunity, 21: 137–148.
[22] Santoiemma, P. P, and Powell, DJ. Jr. (2015) Tumor infiltrating lymphocytes in ovarian cancer. Cancer Biol Ther, 16: 807–820.
[23] Gabrilovich, D. I., and Nagaraj, S. (2009) Myeloid-derived suppressor cells as regulators of the immune system. Nat Rev Immunol, 9: 162-174.
[24] Condeelis, J., and Pollard, J. W. (2006) Macrophages: obligate partners for tumor cell migration, invasion, and metastasis. Cell, 124: 263–266.
[25] Unitt, E., Marshall, A., Gelson, W., Rushbrook, S. M, Davies, S., et al. (2006) Tumour lymphocytic infiltrate and recurrence of hepatocellular carcinoma following liver transplantation. J Hepatol, 45: 246–253.
[26] Gao, Q., Qiu, S. J., Fan, J., Zhou, J., Wang, X. Y., et al. (2007) Intratumoral balance of regulatory and cytotoxic T cells is associated with prognosis of hepatocellular carcinoma after resection. J Clin Oncol, 25: 2586–2593.
[27] Mano, Y., Aishima, S., Fujita, N., Tanaka, Y., Kubo, Y., et al. (2013) Tumor-associated macrophage promotes tumor progression via STAT3 signaling in hepatocellular carcinoma. Pathobiology, 80: 146–154.
[28] Shi, S., Chen, Q., Ye, L., Yin, D., Li, X., et al. (2017) Prognostic value of systemic inflammation score in patients with hepatocellular carcinoma after hepatectomy. Oncotarget, 8: 79366-79375.‏
[29] Thompson Coon, J., Rogers, G., Hewson, P., Wright, D., Anderson, R., et al. (2007) Surveillance of cirrhosis for hepatocellular carcinoma: systematic review and economic analysis. Health Technol Assess, 11: 1–206.
[30] Zhou, P., Chen, B., Miao, X. Y, Zhou, J. J, Xiong, L., et al. (2019) Comparison of FIB-4 score and Child-Pugh Score in Predicting the Outcome of Hepatic Resection for Hepatocellular Carcinoma. Journal of Gastrointestinal Surgery, 23: 1-9.‏
[31] Hegazy, O., Allam, M., Sabry, A., Kohla, M. A. S., Abogharbia, W., et al. (2019) Liver stiffness measurement by transient elastography can predict outcome after hepatic resection for hepatitis C virus-induced hepatocellular carcinoma. The Egyptian Journal of Surgery, 38: 313-318.‏
[32] Lei, J. W, Ji, X. Y, Hong, J. F, Li, W. B, Chen, Y., et al. (2017) Prediction of posthepatectomy liver failure using transient elastography in patients with hepatitis B related hepatocellular carcinoma. BMC gastroenterology, 17: 171.
[33] Kuramitsu, K., Sverdlov, D. Y, Liu, S. B, Csizmadia, E., Burkly, L., et al. (2013) Failure of fibrotic liver regeneration in mice is linked to a severe fibrogenic response driven by hepatic progenitor cell activation. The American journal of pathology, 183: 182-194.‏
[34] Kato, A., Bamba, H., Shinohara, M., Yamauchi, A., Ota, S., et al. (2005) Relationship between expression of cyclin D1 and impaired liver regeneration observed in fibrotic or cirrhotic rats. Journal of gastroenterology and hepatology, 20: 1198-1205.‏
[35] Jalan, R., Fernandez, J., Wiest, R., Schnabl, B., Moreau, R., et al. (2014) Bacterial infections in cirrhosis: a position statement based on the EASL Special Conference 2013. Journal of hepatology, 60: 1310-1324.
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  • APA Style

    Mona Nasef, Lobna Abo Ali, Mohammed Hablus, Hossam Eldeen Soliman, Nehad Hawash, et al. (2020). Fibroscan and FIB-4 Assessment Versus Lymphocyte / Monocyte Ratio as Predictors of Post-Hepatectomy Liver Failure in HCV Egyptian Patients with Hepatocellular Carcinoma. International Journal of Medical Imaging, 8(4), 93-101. https://doi.org/10.11648/j.ijmi.20200804.15

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    ACS Style

    Mona Nasef; Lobna Abo Ali; Mohammed Hablus; Hossam Eldeen Soliman; Nehad Hawash, et al. Fibroscan and FIB-4 Assessment Versus Lymphocyte / Monocyte Ratio as Predictors of Post-Hepatectomy Liver Failure in HCV Egyptian Patients with Hepatocellular Carcinoma. Int. J. Med. Imaging 2020, 8(4), 93-101. doi: 10.11648/j.ijmi.20200804.15

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    AMA Style

    Mona Nasef, Lobna Abo Ali, Mohammed Hablus, Hossam Eldeen Soliman, Nehad Hawash, et al. Fibroscan and FIB-4 Assessment Versus Lymphocyte / Monocyte Ratio as Predictors of Post-Hepatectomy Liver Failure in HCV Egyptian Patients with Hepatocellular Carcinoma. Int J Med Imaging. 2020;8(4):93-101. doi: 10.11648/j.ijmi.20200804.15

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  • @article{10.11648/j.ijmi.20200804.15,
      author = {Mona Nasef and Lobna Abo Ali and Mohammed Hablus and Hossam Eldeen Soliman and Nehad Hawash and Nadia Elwan},
      title = {Fibroscan and FIB-4 Assessment Versus Lymphocyte / Monocyte Ratio as Predictors of Post-Hepatectomy Liver Failure in HCV Egyptian Patients with Hepatocellular Carcinoma},
      journal = {International Journal of Medical Imaging},
      volume = {8},
      number = {4},
      pages = {93-101},
      doi = {10.11648/j.ijmi.20200804.15},
      url = {https://doi.org/10.11648/j.ijmi.20200804.15},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijmi.20200804.15},
      abstract = {Background: Post-hepatectomy liver failure (PHLF) is the most leading cause of mortality in patients diagnosed with hepatocellular carcinoma (HCC) and undergoing resection of the affected part of the liver. Objectives: This research aimed to determine the value of the lymphocyte to monocyte ratio (LMR), fibrosis score 4 (FIB-4) and liver stiffness measurements (LSM) using Fibroscan as pre-operative predictors of PHLF in Egyptian patients with post- hepatitis C virus (HCV) liver cirrhosis and HCC. Methods: In this prospective cohort study definition of PHLF was done according to the “50-50 criteria”. Multivariate analysis was done to identify PHLF independent predictors. The predictive accuracy of the pre-operative LMR, FIB-4 and LSM with Fibroscan were evaluated by receiver operating characteristic (ROC) curve. Results: Enrollment of fifty Egyptian patients was done. 14 patients (28%) experienced PHLF. The presence of oesophageal varices, serum AST, serum albumin, LMR, FIB-4 score, and LSM (P<0.05) were independent pre-operative predictors for PHLF. According to ROC curve analysis, LMR yielded the best accuracy for predicting PHLF at cutoff <3.33 [AUC = 0.940; sensitivity = 93.65%; specificity = 94.44%; positive predictive value = 86.67%; negative predictive value = 97.14%]. FIB-4 score and LSM had lower AUC (0.886 and 0.875) respectively. Conclusion: The pre-operative LMR has a higher predictive ability for PHLF in patients with HCV-related HCC undergoing hepatectomy compared with FIB-4 score and LSM using Fibroscan.},
     year = {2020}
    }
    

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  • TY  - JOUR
    T1  - Fibroscan and FIB-4 Assessment Versus Lymphocyte / Monocyte Ratio as Predictors of Post-Hepatectomy Liver Failure in HCV Egyptian Patients with Hepatocellular Carcinoma
    AU  - Mona Nasef
    AU  - Lobna Abo Ali
    AU  - Mohammed Hablus
    AU  - Hossam Eldeen Soliman
    AU  - Nehad Hawash
    AU  - Nadia Elwan
    Y1  - 2020/11/24
    PY  - 2020
    N1  - https://doi.org/10.11648/j.ijmi.20200804.15
    DO  - 10.11648/j.ijmi.20200804.15
    T2  - International Journal of Medical Imaging
    JF  - International Journal of Medical Imaging
    JO  - International Journal of Medical Imaging
    SP  - 93
    EP  - 101
    PB  - Science Publishing Group
    SN  - 2330-832X
    UR  - https://doi.org/10.11648/j.ijmi.20200804.15
    AB  - Background: Post-hepatectomy liver failure (PHLF) is the most leading cause of mortality in patients diagnosed with hepatocellular carcinoma (HCC) and undergoing resection of the affected part of the liver. Objectives: This research aimed to determine the value of the lymphocyte to monocyte ratio (LMR), fibrosis score 4 (FIB-4) and liver stiffness measurements (LSM) using Fibroscan as pre-operative predictors of PHLF in Egyptian patients with post- hepatitis C virus (HCV) liver cirrhosis and HCC. Methods: In this prospective cohort study definition of PHLF was done according to the “50-50 criteria”. Multivariate analysis was done to identify PHLF independent predictors. The predictive accuracy of the pre-operative LMR, FIB-4 and LSM with Fibroscan were evaluated by receiver operating characteristic (ROC) curve. Results: Enrollment of fifty Egyptian patients was done. 14 patients (28%) experienced PHLF. The presence of oesophageal varices, serum AST, serum albumin, LMR, FIB-4 score, and LSM (P<0.05) were independent pre-operative predictors for PHLF. According to ROC curve analysis, LMR yielded the best accuracy for predicting PHLF at cutoff <3.33 [AUC = 0.940; sensitivity = 93.65%; specificity = 94.44%; positive predictive value = 86.67%; negative predictive value = 97.14%]. FIB-4 score and LSM had lower AUC (0.886 and 0.875) respectively. Conclusion: The pre-operative LMR has a higher predictive ability for PHLF in patients with HCV-related HCC undergoing hepatectomy compared with FIB-4 score and LSM using Fibroscan.
    VL  - 8
    IS  - 4
    ER  - 

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Author Information
  • Tropical Medicine and Infectious Diseases Department, Faculty of Medicine, Tanta University, Tanta, Egypt

  • Tropical Medicine and Infectious Diseases Department, Faculty of Medicine, Tanta University, Tanta, Egypt

  • Gastrointestinal, Liver and Laparoscopic Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt

  • HPB and Liver transplantation surgery Department, National Liver Institute, Menoufia University, Menoufia, Egypt

  • Tropical Medicine and Infectious Diseases Department, Faculty of Medicine, Tanta University, Tanta, Egypt

  • Tropical Medicine and Infectious Diseases Department, Faculty of Medicine, Tanta University, Tanta, Egypt

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