Comparison of the New Neo-Glasgow Prognostic Score Based on the Albumin-Bilirubin Grade with Currently Used Nutritional Indices for Prognostic Prediction following Surgical Resection of Hepatocellular Carcinoma: A Multicenter Retrospective Study in Japan.
Nutritional assessment is important for predicting a prognosis in hepatocellular carcinoma (HCC). The authors examined the utility of the recently developed neo-Glasgow prognostic score (GPS) as a nutritional prognostic assessment in HCC in a multicenter retrospective study of 271 patients with HCC and Child-Pugh class A liver function who underwent R0 resection between 2011 and 2013. The median age was 72 years, 229 and 42 patients had Child-Pugh scores of 5 and 6, respectively, 223 patients had single tumors, the median tumor size was 3.6 cm, and open and laparoscopic resection were performed in 138 and 133 patients, respectively. We compared the prognostic predictive utility of the prognostic nutritional index, neutrophil/lymphocyte and platelet/lymphocyte ratios, controlling nutritional status score, GPS, and neo-GPS, which uses albumin-bilirubin grade (ALBI) instead of albumin. The c-indexes for the predictive prognostic value for overall survival (OS) and progression-free survival (PFS) were best for neo-GPS (OS: 0.571 vs. ≤0.555; PFS: 0.555 vs. ≤0.546). In multivariate analysis with the Cox proportional hazards model, elevated alpha-fetoprotein (AFP; ≥100 ng/mL; hazard ratio [HR] 2.190, 95% confidence interval [CI] 1.493-3.211, < 0.001), multiple tumors (HR 1.784, 95%CI 1.178-2.703, = 0.006), tumor size of ≥5 cm (HR 1.508, 95%CI 1.037-2.193, = 0.032), and neo-GPS of ≥1 (HR 1.554, 95%CI 1.074-2.247, = 0.019) were significant prognostic factors for OS, whereas elevated AFP (≥100 ng/mL) (HR 1.743, 95%CI 1.325-2.292, < 0.001), multiple tumors (HR 1.537, 95%CI 1.148-2.057, = 0.004), and neo-GPS of ≥1 (HR 1.522, 95%CI 1.186-1.954, = 0.001) were significant prognostic factors for PFS. A neo-GPS of ≥1 was associated with a higher rate of high-grade (≥3) Clavien-Dindo complications than a neo-GPS of <1 (31.1% vs. 17.0%, = 0.007). Neo-GPS was a good prognostic nutritional assessment tool for the prediction of postoperative complications and prognosis in patients undergoing surgical HCC resection.
Short-Term and Long-Term Curative Effect of Partial Hepatectomy on Ruptured Hemorrhage of Primary Liver Cancer after TAE.
Emergency medicine international
Objective:To observe the short-term and long-term curative effects of partial hepatectomy on ruptured hemorrhage of primary liver cancer after transcatheter arterial embolization (TAE). Methods:A total of 150 patients with primary liver cancer treated in the hospital were enrolled as research objects between February 2018 and February 2021, including 75 cases undergoing TAE in the TAE group and the other 75 cases undergoing elective partial hepatectomy after TAE in the combination group. The surgical related indexes (leaving bed time, discharge time, success rate of hemostasis, lesion clearance rate), mean arterial pressure (MAP), heart rate (HR), hemoglobin, and liver function indexes (serum alpha-fetoprotein (AFP), albumin (ALB), total bilirubin (TBIL)) before and after treatment, postoperative complications, survival rate, and recurrence rate at 1 year after surgery between the two groups were compared. Results:Compared with the TAE group, hospitalization time was shorter ( < 0.05), the success rate of hemostasis and lesions clearance rate were higher in the combination group ( < 0.05). After surgery, levels of HR and serum AFP were significantly decreased, while levels of MAP, hemoglobin, serum ALB, and TBIL were significantly increased in both groups. The levels of HR and serum AFP in the combination group were lower than those in the TAE group, while levels of MAP, hemoglobin, serum ALB, and TBIL were higher than those in the TAE group ( < 0.05). There was no significant difference in the incidence of postoperative complications between the two groups ( < 0.05). Compared with the TAE group, the recurrence rate was lower, and the survival rate was higher in the combination group at 1 year after surgery ( < 0.05). Conclusion:Partial hepatectomy can effectively improve hemostatic effect and liver function in ruptured hemorrhage of primary liver cancer after TAE, increase survival rate, and reduce postoperative recurrence rate.
Preoperative fibrinogen-to-albumin ratio predicts the prognosis of patients with hepatocellular carcinoma subjected to hepatectomy.
BACKGROUND:Systemic inflammatory response (SIR) plays a crucial role in every step of tumorigenesis and development. More recently, the fibrinogen-to-albumin ratio (FAR), an inflammation-based model, was suggested as a prognostic maker for various cancer patients. This research aimed to estimate the prognostic abilities of FAR, neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), platelet- lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) in patients with hepatocellular carcinoma (HCC) subjected to curative hepatectomy. METHODS:A total of 1,502 cases who underwent hepatectomy for HCC were included. The predictive performances of FAR, NLR, MLR, PLR and SII were assessed with regards to overall survival (OS) and disease-free survival (DFS). The area under the time-dependent receiver operating characteristic curve was used to compare prognostic performances. RESULTS:Data revealed that FAR had higher predictive accuracy than other inflammation-based models and alpha-fetoprotein (AFP) in assessing OS and DFS. Indeed, the OS and DFS of patients with high FAR (> 8.9), differentiated by the optimal cut-off value of FAR, were remarkably reduced (p < 0.05 for OS and DFS). Multivariate Cox regression analyses identified that AFP, FAR, clinically significant portal hypertension, tumor size, Barcelona Clinical Liver Cancer staging system, major resection and blood loss were independent indicators for predicting OS and DFS. Furthermore, these patients could be classified according to their FAR into significantly different subgroups, regardless of AFP levels (p < 0.05 for DFS and OS). Similar results were obtained in other inflammation-based prognostic models. CONCLUSIONS:Compared with NLR, MLR, PLR, SII and AFP, FAR showed significant advantages in predicting survival of HCC patients subjected to liver resection.