title: Safety validation of decision trees for hepatocellular carcinoma.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors: Xian-Qiang Wang, Ke-Sen Xu, Jia-Hong Dong, Department of Hepatobiliary Surgery, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China.
authors: Xian-Qiang
authors: XQ
authors: Wang
authors: Xian-Qiang Wang, Ke-Sen Xu, Jia-Hong Dong, Department of Hepatobiliary Surgery, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China.
authors: Zhe
authors: Z
authors: Liu
authors: Xian-Qiang Wang, Ke-Sen Xu, Jia-Hong Dong, Department of Hepatobiliary Surgery, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China.
authors: Wen-Ping
authors: WP
authors: Lv
authors: Xian-Qiang Wang, Ke-Sen Xu, Jia-Hong Dong, Department of Hepatobiliary Surgery, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China.
authors: Ying
authors: Y
authors: Luo
authors: Xian-Qiang Wang, Ke-Sen Xu, Jia-Hong Dong, Department of Hepatobiliary Surgery, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China.
authors: Guang-Yun
authors: GY
authors: Yang
authors: Xian-Qiang Wang, Ke-Sen Xu, Jia-Hong Dong, Department of Hepatobiliary Surgery, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China.
authors: Chong-Hui
authors: CH
authors: Li
authors: Xian-Qiang Wang, Ke-Sen Xu, Jia-Hong Dong, Department of Hepatobiliary Surgery, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China.
authors: Xiang-Fei
authors: XF
authors: Meng
authors: Xian-Qiang Wang, Ke-Sen Xu, Jia-Hong Dong, Department of Hepatobiliary Surgery, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China.
authors: Yang
authors: Y
authors: Liu
authors: Xian-Qiang Wang, Ke-Sen Xu, Jia-Hong Dong, Department of Hepatobiliary Surgery, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China.
authors: Ke-Sen
authors: KS
authors: Xu
authors: Xian-Qiang Wang, Ke-Sen Xu, Jia-Hong Dong, Department of Hepatobiliary Surgery, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China.
authors: Jia-Hong
authors: JH
authors: Dong
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D001663:Bilirubin / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D002681:China; D003661:Decision Support Techniques; D003663:Decision Trees; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000401:mortality; D006769:Hospitals, General; D006801:Humans; D017093:Liver Failure / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; 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
chemical_list: D001663:Bilirubin
keywords: Decision tree; Hepatectomy; Liver failure