Development of Models to Predict Postoperative Complications for Hepatitis B Virus-Related Hepatocellular Carcinoma

Background: Surgical treatment remains the best option for patients with hepatocellular carcinoma (HCC) caused by chronic hepatitis B virus (HBV) infection. However, there is no optimal tool based on readily accessible clinical parameters to predict postoperative complications. Herein, our study aimed to develop models which permitted risk of severe complications to be assessed before and after liver resection based on conventional variables. Methods: A total of 1047 patients treated by hepatectomy for HCC with HBV infection at three different centers were recruited retrospectively between July 1, 2014, and July 1, 2018. All surgical complications were recorded and scored by the comprehensive complication index (CCI). A CCI ≥26.2 was used as a threshold to define patients with severe complications. We built 2 models for the CCI, 1 using preoperative and 1 using pre and post-operative data. Besides, CCI and other potentially relevant factors were evaluated for their ability to predict early recurrence and metastasis. All the findings were internally validated in the Hangzhou cohort and then externally validated in Lanzhou and Urumqi cohorts. Results: Multivariable analysis identified National Nosocomial Infections Surveillance (NNIS) index, tumor number, gamma-glutamyltransferase (GGT), total cholesterol (TC), potassium and thrombin time as the key preoperative parameters related to perioperative complications. The nomogram based on the preoperative model (CCIASL-pre) showed good discriminatory performance internally and externally. A more accurate model (CCIASL-post) was established, combined with the other four postoperative predictors including leukocyte count, basophil, erythrocyte count and total bilirubin. No significant association was observed between CCI and long-term complications. Conclusion: Based on the widely available clinical data, statistical models were established to predict the complications after hepatectomy in patients with HBV infection. All the findings were extensively validated and shown to be applicable nationwide. Such models could be used as guidelines for surveillance follow-up and the design of post-resection adjuvant therapy.