Predicting Post-hepatectomy Liver Failure for Patients with Hepatocellular Carcinoma Undergoing Major Liver Resection: A Multicenter Retrospective Study

Abstract

Background Post-hepatectomy liver failure (PHLF) is a serious complication after liver resection for hepatocellular carcinoma (HCC). However, reliable predictive models for PHLF in patients undergoing major hepatectomy remain limited. This study aimed to predict PHLF using clinical factors and to evaluate its impact on short-and long-term outcomes for patients with HCC undergoing major liver resection. Methods This multicenter retrospective study included 1037 patients undergoing liver resection exceeding sectionectomy across three high-volume centers between 2012 and 2021. The study defined PHLF using the 50/50 criteria (serum bilirubin > 50 & micro;mol/L [2.93 mg/dL] and prothrombin time < 50% on postoperative day 5). The final study cohort comprised 925 patients: 65 (7.0%) patients in the PHLF group and 860 patients (93.0%) in the non-PHLF group. Results The PHLF group showed a significantly higher major complication rate (20 [30.8%] vs. 61 [7.1%]; P < 0.001) and 90-day mortality rate (6 [9.2%] vs. 12 [1.4%]; P = 0.001) than the non-PHLF group. The PHLF group also demonstrated worse long-term survival than the non-PHLF group (5-year survival, 52.8% vs. 78.8%; P < 0.001). Multivariate logistic regression analysis identified positive hepatitis B surface antigen, platelet count, indocyanine green retention rate at 15 min, albumin-bilirubin grade, and number of resected segments as independent risk factors for PHLF (all P < 0.05). A nomogram incorporating these factors showed good predictive performance (area under the curve, 0.771), which was maintained on internal cross-validation. Conclusions For HCC patients undergoing major liver resection, PHLF significantly impacts both short-term complications and long-term outcomes. The developed prediction model enables PHLF risk assessment and facilitates tailored surgical planning.