title: Correlation between the serum levels of type IV collagen 7s domain and the risk of intractable ascites following liver resection for hepatocellular carcinoma: A propensity score-matched analysis.
abstract: The severity of liver fibrosis has been reported to be correlated with the risk of intractable ascites after hepatectomy for hepatocellular carcinoma. Since 2009, we have measured routinely the serum concentrations of type IV collagen 7s domain (7s collagen), a biochemical marker of liver fibrosis and applied limited resection to patients with elevation of the serum 7s collagen concentrations above the upper limit of normal (6.0 ng/mL). The aim of this study was to assess the potential benefits of our treatment strategy on the postoperative outcomes of patients with hepatocellular carcinoma.
  
  
  
  A propensity score-matched analysis was performed to compare the outcomes between patients who underwent initial hepatectomy for hepatocellular carcinoma before or after 2009 (2009 to April 2015; period 2) and those who underwent the operation prior to 2009 (1990-2008; period 1; n = 129 in each period).
  
  
  
  The incidence of intractable ascites was significantly lower in period 2 than in period 1 (2.3 vs 14.7%; P < .001), although the other short-term and long-term outcomes were comparable between the 2 groups. A multivariate analysis identified elevation of the serum 7s collagen concentrations to ≥7.4 ng/mL as an independent predictor of IA (odds ratio 14.1, 95% confidence interval 2.8 to 106.7; P = .001), with the area under the receiver-operating characteristic curve of 0.820 (0.648-0.919, P = .005).
  
  
  
  Modification of the surgical procedure according to the serum 7s collagen concentration is beneficial for reducing the risk of development of intractable ascites after hepatectomy for hepatocellular carcinoma.
authors: First Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
authors: Akira
authors: A
authors: Shimizu
authors: First Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan. Electronic address: kbys@shinshu-u.ac.jp.
authors: Akira
authors: A
authors: Kobayashi
authors: First Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
authors: Takahide
authors: T
authors: Yokoyama
authors: First Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
authors: Hiroaki
authors: H
authors: Motoyama
authors: First Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
authors: Hiroshi
authors: H
authors: Sakai
authors: First Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
authors: Noriyuki
authors: N
authors: Kitagawa
authors: First Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
authors: Tsuyoshi
authors: T
authors: Notake
authors: First Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
authors: Tomoki
authors: T
authors: Shirota
authors: First Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
authors: Kentaro
authors: K
authors: Fukushima
authors: First Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
authors: Shin-Ichi
authors: SI
authors: Miyagawa
mesh_terms: D000328:Adult; D000368:Aged; D001201:Ascites / Q000209:etiology* / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000401:mortality / Q000601:surgery*; D016022:Case-Control Studies; D024141:Collagen Type IV / Q000097:blood*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007564:Japan; D008113:Liver Neoplasms / Q000097:blood / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood / Q000401:mortality / Q000503:physiopathology; D057216:Propensity Score; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D024141:Collagen Type IV