• Taegyu Kim, Bong-Wan Kim, Hee-Jung Wang, Hyun Young Lee, Je Hwan Won, Jinoo Kim, Xu-Guang Hu, Joohyun Sim, Jun Bae Bang, and Young Bae Kim.
• *Department of Liver Transplantation and Hepatobiliary Surgery, Ajou University School of Medicine, Suwon, South Korea†Department of Biostatistics, Clinical Trial Center, Ajou University School of Medicine, Suwon, South Korea‡Department of Radiology, Ajou University School of Medicine, Suwon, South Korea§Department of Pathology, Ajou University School of Medicine, Suwon, South Korea.
• Ann. Surg. 2016 Aug 1; 264 (2): 330-8.

ObjectiveTo establish a reliable equation to predict hepatic venous pressure gradient (HVPG) using serological tests for surgical patients with hepatocellular carcinoma (HCC).BackgroundAccurate assessment of portal pressure for surgical patients with HCC is important for safe hepatic resection (HR). The HVPG is regarded as the most reliable method to detect portal hypertension. However, HVPG is not utilized in many medical centers due to invasiveness of procedure.MethodsBetween 2006 and 2008, 171 patients (Correlation cohort), who underwent liver surgery in a tertiary hospital, were enrolled. Preoperative measurements of the HVPG and serological tests were performed simultaneously. Correlation between the HVPG and serological tests were analyzed to establish an equation for calculated HVPG (cHVPG). Between 2008 and 2013, 510 surgical patients (Application cohort) were evaluated, and HR recommended when cHVPG < 10 mm Hg. The outcomes of HR were analyzed to evaluate reliability of the cHVPG for HR.ResultsIn the correlation cohort, the equation for cHVPG was established using multivariate linear regression analysis; cHVPG (mm Hg) = 0.209 × [ICG-R15 (%)] - 1.646 × [albumin (g/dL)] - 0.01×[platelet count (10)] + 1.669 × [PT-INR] + 8.911. In the application cohort, 425 patients with cHVPG < 10 mm Hg underwent HR. Among them, 357 had favorable value of ICG-R15 < 20% (group A), and 68 had unfavorable value of ICG-R15 ≥ 20% (group B). There was no significant difference in patient demographics, tumor characteristics, operative outcome, and survival rates between group A and B.ConclusionsThe equation for cHVPG of this study was established on statistical reliability. The cHVPG could be useful to predict portal pressure quantitatively for surgical patients with HCC using serological tests.

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