Preoperative albumin-bilirubin grade combined with aspartate aminotransferase-to-platelet count ratio index predict outcomes of patients with hepatocellular carcinoma within Milan criteria after liver resection

Abstract

Hepatocellular carcinoma (HCC) is one of the most common malignancies and is ranked the third most frequent cancer-related mortality worldwide (1). Every year, more than 800,000 new cases are diagnosed, and mortality is high due to the poor prognosis of HCC (2). Liver resection is widely accepted as a curative treatment for HCC patients with well-compensated liver function. However, the 5-year overall survival for HCC patients after liver resection remains unsatisfactory due to the high incidence of postoperative recurrence (3). Some investigations suggest as many as 51.6-70.3% of patients with HCC within Milan criteria will suffer from recurrence after liver resection (4,5). Liver function greatly influences the prognosis of HCC patients. Patients with poor liver function are at high risk for postoperative complications and tend to Summary There is little information concerning the prognostic significance of combined albuminbilirubin (ALBI) grade and aspartate aminotransferase-to-platelet count ratio index (APRI) in hepatocellular carcinoma (HCC). Therefore, we performed this study to assess the prognostic utility of combining ALBI and APRI (ALBI-APRI score) for predicting the prognosis of patients with HCC within Milan criteria after liver resection. Two hundred thirty-nine patients were involved in this study. Patients with a high APRI score were allocated a score of 1, whereas patients with a low APRI score were allocated a score of 0. The ALBI-APRI score is the summation of APRI score and ALBI grade. The area under the receiver operating characteristic curve (AUC) was used to estimate the predictive accuracy of different models. During the study period, 132 patients experienced recurrence, and 52 patients died. Multivariate analysis revealed the ALBI-APRI score (HR = 1.753, 95% CI = 1.293-2.377, p < 0.001), presence of microvascular invasion (MVI, HR = 2.693, 95%CI = 1.832-3.960, p < 0.001) and multiple tumors (HR = 1.973, 95% CI = 1.300-2.995, p = 0.001) were all associated with recurrence. In addition, blood transfusion (HR = 3.113, 95% CI = 1.677-5.778, p < 0.001), high preoperative alpha-fetoprotein (AFP, HR = 2.272, 95% CI = 1.298-3.976, p = 0.004), ALBI-APRI score (HR = 2.046, 95% CI = 1.237-3.382, p = 0.005) and presence of MVI (HR = 4.524, 95% CI = 2.514-8.140, p < 0.001) were correlated with postoperative mortality. The AUCs of ALBI-APRI score were significantly higher than either ALBI or APRI alone for predicting both postoperative recurrence and mortality. ALBI-APRI score may be a predictor for the prognosis of patients with HCC within Milan criteria following liver resection. A more well-designed and large-scale study are warranted to prove our findings.

Association of Low Serum Albumin Level with Higher Hepatocellular Carcinoma Recurrence in Patients with Hepatitis B Virus Pre-S2 Mutant after Curative Surgical Resection

“…Multiple studies validated the prognostic value of serum albumin level in combination with other clinicopathological factors in predicting HCC recurrence after curative surgical resection, such as the albumin–bilirubin grade combined with the fibrosis-4 index, platelet-to-lymphocyte ratio, aspartate aminotransferase-to-platelet ratio, TNM stage, or clinically significant portal hypertension [ 28 , 29 , 30 , 31 , 32 , 33 ]. However, the prognostic performance of serum albumin level, either alone or combined with hepatitis B viral factors, for HBV-related HCC recurrence remains poorly explored.…”

Albumin-bilirubin score as a predictor of all-cause mortality in patients with hepatitis B virus infection: An analysis of National Health and Nutrition Examination Survey (NHANES) 1999–2018

“…Liu et al used several tools to predict mortality in patients with hepatocellular carcinoma, with an AUC of 0.704 for the ALBI score to predict patient 3-year mortality ( Liu et al, 2017 ). Furthermore, the use of the ALBI score in combination with other indicators for predicting the prognosis of patients with hepatocellular carcinoma was reported, such as the combined ALBI score-FIB-4 indicator ( Zhang et al, 2019 ) and the combined ALBI score-aspartate aminotransferase-to-platelet count ratio index (APRI) ( Luo et al, 2019 ). The ALBI score was used to assess liver function, and both the FIB-4 index and the APRI indicator were used to assess the severity of liver fibrosis.…”

Are inflammation-based markers useful in patients with hepatocellular carcinoma and clinically significant portal hypertension after liver resection?

“…Clinically significant portal hypertension (CSPH) was defined by the presence of esophagogastric varices and/or a platelet count < 100 × 10 9 /L in association with splenomegaly (9). The definitions of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), prognostic nutrition index (PNI), systemic immune-inflammation index (SII), aspartate aminotransferase-to-platelet count ratio index (APRI) and albumin-bilirubin (ALBI) grade are listed in Table 1 (10)(11)(12)(13)(14)(15). NLR ≥ 3 was defined as being high (10).…”

“…SII ≥ 330 was considered high (12). PRI ≥ 0.5 was considered high (13,14). ALBI values were divided into 3 grades: grade 1 (less than -2.60), grade 2 (between -2.60 and -1.39) and grade 3 (above -1.39) (15).…”