A Novel Scoring System To Predict Ascites Development Post Hepatectomy For Bclc Stage B Hepatocellular Carcinoma

Background: To develop a novel scoring system to predict the development of post-operative ascites by analyzing clinicopathological characteristics and risk factors of BCLC stage B hepatocellular carcinoma.Methods: Prospective analysis was performed on consecutive patients with BCLC stage B hepatocellular carcinoma, who underwent hepatectomy from January 2005 to December 2014.Results: A total of 181 patients were enrolled, of whom 34.3% (62/181) developed post-operative ascites. Comparing with patients without ascites, patients who developed ascites had longer drain placement, more incidence of pleural effusion, more incidence of intra-abdominal infection and longer inpatient stay. All differences were statistically significant (P<0.01). A univariate analysis showed that the following factors were associated with the development of ascites: gender, prothrombin time (PT), prothrombin activity (PTA), platelet count (PLT), aspartate transaminase (AST), duration of operation, future liver remnant (FLR) <50%, blood loss, and transfusion of plasma or red blood cells during operation. On multivariate analysis, PLT, FLR <50%, transfusion of plasma or red blood cell during operation were independently associated with post-operative ascites accumulation. A predictive scoring system was established using the factors above and the patients with scores >= 5 had high risk of developing post-operative ascites [sensitivity =96.8%, specificity =90.8%, and area under the curve (AUC) =0.972].Conclusions: The development of post-operative ascites was associated with various clinicopathological factors. The scoring system, which incorporates these factors, provided a valuable means for predicting the development of post-operative ascites. Early identification of these at-risk patients might help to improve their perioperative outcome.