An mALBI-Child–Pugh-based nomogram for predicting post-hepatectomy liver failure grade B–C in patients with huge hepatocellular carcinoma: a multi-institutional study

Abstract

Objective Post-hepatectomy liver failure (PHLF) is a severe complication in patients with hepatocellular carcinoma (HCC) who underwent hepatectomy. This study aims to develop a nomogram of PHLF grade B–C in patients with huge HCC (diameter ≥ 10 cm). Methods We retrospectively collected clinical information of 514 and 97 patients who underwent hepatectomy for huge HCC at two medical centers between 2016 and 2021. Univariate and multivariate analysis were carried out to screen the independent risk factors of PHLF grade B–C, which were visualized as a nomogram. Results Three Hundred Forty Three Thousand One Hundred Seventy One and 97 HCC patients were included in the training cohort, internal validation cohort, and external validation cohort, with probabilities of PHLF grade B–C of 15.1%, 12.9%, and 22.7%, respectively. Pre-operative modified albumin-bilirubin (mALBI) grade (p < 0.001), Child–Pugh classification (p = 0.044), international normalized ratio (INR) (p = 0.005), cirrhosis (p = 0.019), and intraoperative blood loss (p = 0.004) were found to be independently associated with PHLF grade B–C in the training cohort. All the five independent factors were considered in the establishment of the nomogram model. In the internal validation cohort and external validation cohort, the area under receiver operating characteristic curve for the nomogram in PHLF grade B–C prediction reached 0.823 and 0.740, respectively. Divided into different risk groups according to the optimal cut-off value, patients in the high-risk group reported significantly higher frequency of PHLF grade B–C than those in the low-risk group, both in the training cohort and the validation cohort (p < 0.001). Conclusions The proposed noninvasive nomogram based on mALBI-Child–Pugh and three other indicators achieved optimal prediction performance of PHLF grade B–C in patients with huge HCC.

Developing and validating a nomogram based on skeletal muscle index and clinical scoring system for prediction of liver failure after hepatectomy

“…Therefore it is less accurate for the diagnosis of early occult cirrhosis, while its inclusion of intraoperative blood loss, like that of Xu, makes it difficult to assess PHLF preoperatively. Meanwhile, its inclusion of tumor size is subjective and without a stated criterion for judging ( 28 ). Chin developed a model to predict PHLF, but the model included patients with colorectal cancer with liver metastases who received preoperative neoadjuvant chemotherapy, and the model was not validated, so it is uncertain whether it can predict PHLF accurately in other data sets ( 29 ).…”

Inflammatory Markers Showed Significant Incremental Value for Predicting Post-Hepatectomy Liver Failure in Hepatocellular Carcinoma Patients

“…As previous studies have demonstrated, high levels of serum inflammatory markers are strongly associated with poor prognosis in cirrhosis and solid tumors. Cirrhosis is an important indicator for the preoperative evaluation of liver function and surgical feasibility and has been used as the final predictor by several PHLF prediction models, including reference nomogram [19,39,40]. Thus, it is not surprising that PCT and SII can improve the model's predictive ability of PHLF in patients with HCC.…”

The Association Between Modified Albumin-Bilirubin (mALBI) and Survival in Advanced Non-small Cell Lung Cancer Patients Treated With Immunotherapy

“…According to previous reports, the calculation formula for ALBI grade is as follows: ALBI score=(\log_{10} {Bilirubin}\times 0.66-0.085\times albumin), where the unit for bilirubin is µmol/L and albumin is g/L [21].…”

“…The ALBI and mALBI grades are classified and presented in Table 1 [21]. The neutrophil-lymphocyte ratio (NLR) is calculated as the number of neutrophils divided by the number of lymphocytes (NLR=\frac{neutrophil count}{lymphocyte count} ) [18].…”