von Willebrand Factor Antigen Predicts Outcomes in Patients after Liver Resection of Hepatocellular Carcinoma

Abstract

Background/aims: von Willebrand factor antigen (vWF-Ag) is a noninvasive predictor of portal hypertension that serves as a negative prognostic marker in various malignancies. Increased portal hypertension is associated with higher postoperative morbidity and decreased survival after hepatectomy. The purpose of this study was to determine the correlation between vWF-Ag, postoperative morbidity and oncological outcome.

Methods: This analysis includes 55 patients who underwent liver resection for hepatocellular carcinoma (HCC) between 2008 and 2015 with available preoperative vWF-Ag levels. The primary endpoints were postoperative complications and long-term outcome, including overall and disease-free survival.

Results: The median plasma level of vWF-Ag was 191% (range, 162.5% to 277%). There was a significant correlation between vWF-Ag levels and tumor size in the resected specimens (p=0.010, r=0.350). Patients who developed any grade of postoperative complication had significantly higher preoperative vWF-Ag levels (216% [range, 178% to 283.25%] vs 176% [range, 148% to 246%], p=0.041). Median overall survival was 39.8 months in patients with high vWF-Ag levels (≥191%) compared with 73.4 months in patients with low levels (<191%, p=0.007). Of note, there was a remarkable disparity in the number of patients who died of HCC with low versus high vWF-Ag levels (14.8% vs 28.6%, p=0.011).

Conclusions: vWF-Ag may serve as a prognostic marker for the outcome of patients undergoing liver resection for HCC that is closely connected to tumor size, postoperative complication rate and long-term outcome.

Keywords: Carcinoma, hepatocellular; Hepatectomy; Outcome; von Willebrand factor.

Fig. 1

von Willebrand factor antigen (vWF-Ag) levels were higher in patients with any grade of postoperative complication compared with patients without postoperative complications (p=0.041).

Fig. 2

Prognostic impact of preoperatively measured von Willebrand factor antigen (vWF-Ag) levels on long-term outcome after hepatectomy for hepatocellular carcinoma. (A) There was a trend towards reduced disease-free survival (DFS) in patients with a vWF-Ag level ≥191% (median DFS, 22.8 mo vs 33.4 mo, p=NS). (B) Overall survival (OS) was significantly reduced in patients with elevated vWF-Ag levels (39.8 mo vs 73.4 mo, p=0.007). NS, not significant. *p<0.05.