Splenic Volume, an Easy-To-Use Predictor of HCC Late Recurrence for HCC Patients After Hepatectomy

Abstract

Purpose: The high recurrence rate of hepatocellular carcinoma (HCC) has a poor impact on the quality of life and survival time of patients. Especially for late recurrence, poor data are available in analysis. We aim to evaluate whether the splenic volume (SV) measured from preoperative CT images could predict late recurrence in HCC patients after hepatectomy.

Patients and methods: A cohort of 300 HCC patients hospitalized at Xiangya Hospital of Central South University between January 2015 and June 2018 was retrospectively analyzed. The SV was calculated by using automated volumetry software from preoperative CT images. A total of 300 HCC patients were separated into the early recurrence cohort (n=167), the late recurrence cohort (n=39), and the no recurrence cohort (n=94) according to whether there is a recurrence and the recurrence time. Univariate and multivariate Cox analyses were performed to identify the independent risk factors of both early and late recurrence.

Results: AFP, Microvascular invasion (MVI), satellitosis, and BCLC staging were independent risk factors of HCC early recurrence. Splenic volume (HR=1.003, 95%CI:1.001-1.005, P<0.001) was the only predictor of HCC late recurrence. Based on X-tile software, 133 non-early recurrence patients were divided into two groups according to SV: low SV (<165ml, n=45) and high SV (≥165ml, n= 88). The low SV group had a significantly better RFS compared with the high SV group (P=0.015). Nomogram was built on the base of SV to get the probability of 3-year RFS, 4-year RFS, and 5-year RFS.

Conclusion: In our study, we drew a conclusion that splenic volume was the only predictor of HCC late recurrence because of its association with portal hypertension and liver cirrhosis. High splenic volume often indicated a worse recurrence.

Keywords: hepatocellular carcinoma; liver cirrhosis; nomogram; recurrence; splenic volume (SV).

Figure 1

Three-dimensional reconstruction of the spleen was performed for automated volumetry by using medical image analysis software. The splenic volume was calculated after volumetry of the spleen. Red color, spleen; Purple color, tumor; Orange color, liver; Green color, hepatic vein; Blue color, portal vein.

Figure 2

Flowchart of this study.

Figure 3

Kaplan-Meier curve for recurrence-free survival of 300 patients. HCC, hepatocellular carcinoma.

Figure 4

The cut-off values were calculated by using X-tile based on the SV. The cut-off values were 167 for RFS. SV, splenic volume; RFS, recurrence-free survival.

Figure 5

Comparison of RFS in late recurrence patients between two groups (SV<165ml, SV≥165ml). RFS, recurrence-free survival; SV, splenic volume.

Figure 6

The nomogram was developed based on SV. An individual SV value is drawn upward to determine points. Because there is only one variable, the points are the total points, and a line is drawn downward to the likelihood of 3-year RFS, 4-year RFS, and 5-year RFS.