Safety validation of decision trees for hepatocellular carcinoma.
AIM
To evaluate a different decision tree for safe liver resection and verify its efficiency.


METHODS
A total of 2457 patients underwent hepatic resection between January 2004 and December 2010 at the Chinese PLA General Hospital, and 634 hepatocellular carcinoma (HCC) patients were eligible for the final analyses. Post-hepatectomy liver failure (PHLF) was identified by the association of prothrombin time < 50% and serum bilirubin > 50 μmol/L (the "50-50" criteria), which were assessed at day 5 postoperatively or later. The Swiss-Clavien decision tree, Tokyo University-Makuuchi decision tree, and Chinese consensus decision tree were adopted to divide patients into two groups based on those decision trees in sequence, and the PHLF rates were recorded.


RESULTS
The overall mortality and PHLF rate were 0.16% and 3.0%. A total of 19 patients experienced PHLF. The numbers of patients to whom the Swiss-Clavien, Tokyo University-Makuuchi, and Chinese consensus decision trees were applied were 581, 573, and 622, and the PHLF rates were 2.75%, 2.62%, and 2.73%, respectively. Significantly more cases satisfied the Chinese consensus decision tree than the Swiss-Clavien decision tree and Tokyo University-Makuuchi decision tree (P < 0.01，P < 0.01); nevertheless, the latter two shared no difference (P = 0.147). The PHLF rate exhibited no significant difference with respect to the three decision trees.


CONCLUSION
The Chinese consensus decision tree expands the indications for hepatic resection for HCC patients and does not increase the PHLF rate compared to the Swiss-Clavien and Tokyo University-Makuuchi decision trees. It would be a safe and effective algorithm for hepatectomy in patients with hepatocellular carcinoma.
['Wang|Xian-Qiang|XQ|', 'Liu|Zhe|Z|', 'Lv|Wen-Ping|WP|', 'Luo|Ying|Y|', 'Yang|Guang-Yun|GY|', 'Li|Chong-Hui|CH|', 'Meng|Xiang-Fei|XF|', 'Liu|Yang|Y|', 'Xu|Ke-Sen|KS|', 'Dong|Jia-Hong|JH|']
D000328:Adult D000368:Aged D000465:Algorithms D001663:Bilirubin D006528:Carcinoma, Hepatocellular D002681:China D003661:Decision Support Techniques D003663:Decision Trees D005260:Female D006498:Hepatectomy D006769:Hospitals, General D006801:Humans D017093:Liver Failure D008113:Liver Neoplasms D008297:Male D008875:Middle Aged D018579:Patient Selection D011237:Predictive Value of Tests D011517:Prothrombin Time D015203:Reproducibility of Results D012189:Retrospective Studies D018570:Risk Assessment D012307:Risk Factors D013997:Time Factors D016896:Treatment Outcome
Decision tree Liver failure Hepatectomy