Correlation between preoperative serum concentration of type IV collagen 7s domain and hepatic failure following resection of hepatocellular carcinoma

Abstract

Objective: To determine the predictive value of the preoperative serum concentration of type IV collagen 7s domain (7s collagen) for postoperative hepatic failure in patients undergoing liver resection for hepatocellular carcinoma.

Summary background data: Clear and reliable criteria for predicting hepatic failure after liver resection are needed. The serum 7s collagen concentration correlates with the histologic degree of active hepatitis and hepatic fibrosis and may predict the regenerative potential of the liver.

Methods: Potential risk factors for postoperative hepatic failure, including the serum 7s collagen concentration, were evaluated in 251 patients who underwent liver resection for hepatocellular carcinoma. Prognostic significance was determined by univariate and multivariate analyses.

Results: Hepatic failure developed postoperatively in 25 patients, 4 of whom died. The serum 7s collagen concentration correlated with the histologic degree of hepatitis activity and hepatic fibrosis. The serum 7s collagen concentration was a risk factor for postoperative hepatic failure by univariate analysis and was the only risk factor on multivariate analysis. No patient with a serum 7s collagen concentration <12 ng/mL died of postoperative hepatic failure, and all 4 patients who died had a serum 7s collagen concentration >or=12 ng/mL.

Conclusions: The preoperative serum 7s collagen concentration correlated independently with hepatic failure following liver resection for hepatocellular carcinoma. Patients whose serum 7s collagen is >or=12 ng/mL are poor candidates for hepatic resection.

FIGURE 1. The serum 7s collagen concentration in patients who underwent liver resection for hepatocellular carcinoma. The serum 7s collagen concentration distributes from 2.6 to 15.0 ng/mL (mean ± sd, 7.4 ± 2.2 ng/mL). The reference range of the serum 7s collagen concentration is ≤6.0 ng/mL (dotted line).

FIGURE 2. The serum 7s collagen concentration in patients with or without postoperative hepatic failure and operative procedure. Major hepatectomy, segmentectomy or greater; minor hepatectomy, smaller than segmentectomy. Circles, patients without postoperative hepatic failure; open squares, patients with postoperative hepatic failure; closed squares, patients who died of postoperative hepatic failure.

FIGURE 3. The correlation between serum 7s collagen concentration and indocyanine green retention rate at 15 minutes. Circles, patients without postoperative hepatic failure; open squares, patients with postoperative hepatic failure; closed squares, patients who died of postoperative hepatic failure.