Nomogram based on CT–derived extracellular volume for the prediction of post-hepatectomy liver failure in patients with resectable hepatocellular carcinoma

ObjectivesThis study aimed to develop and validate a nomogram based on extracellular volume (ECV) derived from computed tomography (CT) for predicting post-hepatectomy liver failure (PHLF) in patients with resectable hepatocellular carcinoma (HCC).MethodsA total of 202 patients with resectable HCC from two hospitals were enrolled and underwent multiphasic contrast-enhanced CT before surgery. One hundred twenty-one patients from our hospital and 81 patients from another hospital were assigned to the training cohort and the validation cohort, respectively. CT–derived ECV was measured using nonenhanced and equilibrium-phase-enhanced CT images. The nomogram was developed with independent predictors of PHLF. Predictive performance and calibration were assessed by receiver operator characteristic (ROC) analysis and Hosmer–Lemeshow test, respectively. The Delong test was used to compare the areas under the curve (AUCs).ResultsCT–derived ECV had a strong correlation with the postoperative pathological fibrosis stage of the background liver (p < 0.001, r = 0.591). The nomogram combining CT–derived ECV, serum albumin (Alb), and serum total bilirubin (Tbil) obtained higher AUCs than the albumin–bilirubin (ALBI) score for predicting PHLF in both the training cohort (0.828 vs. 0.708; p = 0.004) and the validation cohort (0.821 vs. 0.630; p < 0.001). The nomogram showed satisfactory goodness of fit for PHLF prediction in the training and validation cohorts (p = 0.621 and 0.697, respectively).ConclusionsThe nomogram contributes to the preoperative prediction of PHLF in patients with resectable HCC.Key Points • CT–derived ECV had a strong correlation with the postoperative pathological fibrosis stage of the background liver. • CT–derived ECV was an independent predictor of PHLF in patients with resectable HCC. • The nomogram based on CT–derived ECV showed a superior prediction efficacy than that of clinical models (including Child–Pugh stage, MELD score, and ALBI score).