Abstract
Various noninvasive liver functional reserve models have been proposed, but their prognostic ability in patients with hepatocellular carcinoma (HCC) is unclear. We aimed to investigate the performance of twelve noninvasive liver reserve models in HCC patients undergoing surgical resection. A total of 645 patients undergoing resection were prospectively identified and retrospectively analyzed. Tumor recurrence, overall survival, and independent prognostic factors were evaluated by the Cox proportional hazards model. Of the twelve models, the King’s score showed the highest homogeneity and lowest corrected Akaike information criterion (AICc) value, suggesting a better predictive ability for tumor recurrence. In multivariate Cox analysis, we confirmed that King’s score, tumor size and serum alpha-fetoprotein level were independent predictors associated with recurrence. In survival prediction, albumin-bilirubin (ALBI) revealed the highest homogeneity and lowest value among twelve invasive models, indicating a better prognostic performance. In the Cox model, ALBI grade, tumor burden, alpha-fetoprotein, vascular invasion, diabetes mellitus and performance status were independent predictors linked with overall survival. In summary, the currently used liver function models have differential predictive ability for HCC patients undergoing surgical resection. The King’s score is a feasible tool to predict tumor recurrence, whereas ALBI grade is a more robust model for prognostic prediction.
Highlights
Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide, accounting for more the 700,000 deaths each year[1]
We utilize a prospective hepatocellular carcinoma (HCC) cohort to evaluate the prognostic role of these noninvasive models on tumor recurrence and overall survival in HCC patients undergoing surgical resection
We show that among these noninvasive models, the King’s score is a more feasible marker to predict tumor recurrence and ALBI is the most accurate model in the discrimination of survival for HCC patients
Summary
Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide, accounting for more the 700,000 deaths each year[1]. Other tools to evaluate liver functional reserve include aspartate aminotransferase-to-platelet ratio (APRI), fibrosis index based on 4 factors (FIB-4), King’s score, cirrhosis discriminate index (CDS), Lok index and the Göteborg University Cirrhosis Index (GUCI)[17,18,19,20,21,22]. These models incorporate different clinical parameters such as age and serum biochemistries. This study aimed to investigate the correlation of these noninvasive models and their prognostic impact on tumor recurrence and overall survival in HCC patients undergoing surgical resection
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