Abstract
Simple SummaryGlasgow prognostic score (GPS), using with CRP and albumin has been shown to be an important and useful nutritional assessment tool for predicting prognosis in such cases. We developed a modified GPS scoring method (neo-GPS), based on ALBI grade and reported to indicate the approximate borderline of amino acid imbalance instead of serum albumin, in the present study. The present results indicate that neo-GPS has not only better predictive value for prognosis but also shows greater sensitivity for predicting risk of postoperative complications as compared to GPS in patients undergoing a hepatectomy for hepatocellular carcinoma.Background/Aim: Nutritional assessment is known to be important for predicting prognosis in patients with malignant diseases. This study examined the usefulness of a prognostic predictive nutritional assessment tool for hepatocellular carcinoma (HCC) patients treated with surgical resection. Materials/Methods: HCC patients (n = 429) classified as Child–Pugh A who underwent an R0 resection between 2010 and 2020 were retrospectively analyzed (median age 73 years, males 326 (76.0%), Child–Pugh score 5:6 = 326:103, single tumor 340 (79.2%), median tumor size 3.5 cm, open:laparoscopic = 304:125). Glasgow prognostic score (GPS) and the newly developed neo-GPS method, which uses albumin–bilirubin grade 1 instead of albumin, were evaluated to compare their usefulness for prognosis prediction. Results: Median survival time for patients with a GPS score of 0, 1, and 2 was 120, 51, and 20 months, respectively. As for neo-GPS, that for those with a score of 0, 1, and 2 was not applicable (NA), 53 months, and 35 months, respectively (each p < 0.001; c-index: 0.556 and 0.611, respectively). Furthermore, median progression-free survival was 33, 22, and 9 months, and 41, 24, and 15 months, respectively (each p < 0.001; c-index: 0.539 and 0.578, respectively). As compared to patients with a high GPS (≥1), those with a high neo-GPS (≥1) showed a greater rate of high Clavien–Dindo classification (≥3) (39.2% vs. 65.1%). A comparison of patients with a high GPS (≥1) with those with a high neo-GPS (≥1) showed no significant difference regarding frequency of open or laparoscopic hepatectomy (17.4% vs. 15.2%, p = 0.670; 44.7% vs. 43.2%, p = 0.831, respectively), while the frequency of high Clavien–Dindo classification (≥3) was lower in patients who underwent a laparoscopic hepatectomy (11.2% vs. 22.7%, p = 0.007). Conclusion: The present findings suggest that the newly developed neo-GPS based on ALBI grade is an effective prognostic nutritional assessment tool and can be used for prediction of postoperative complications.
Highlights
Hepatocellular carcinoma (HCC) is known to be the most common primary malignancy of the liver, while worldwide it is the fifth most common of all malignancies [1]
The modified nutritional assessment tool neo-Glasgow prognostic score (GPS) was found to be a better method for predicting prognosis as compared to GPS, for overall survival (OS) and PFS
While there were no significant differences for frequency of high GPS (≥1) and high neo-GPS (≥1) between patients treated with an open hepatectomy (17.4% vs. 15.2%, p = 0.670) and those with a laparoscopic hepatectomy (44.7% vs. 43.2%, p = 0.831), the latter group showed a lower rate of high Clavien–Dindo classification (≥3) (11.2% vs. 22.7%, p = 0.007)
Summary
Hepatocellular carcinoma (HCC) is known to be the most common primary malignancy of the liver, while worldwide it is the fifth most common of all malignancies [1]. An open hepatectomy is the standard surgical treatment conventionally performed for HCC patients, though recently a laparoscopic hepatectomy method has been developed as a less invasive yet equal or more effective therapeutic modality. Along with advancements in techniques and instruments used for a laparoscopy over more than two decades, a laparoscopic hepatectomy has been increasingly adopted worldwide [2,3], as it is associated with a lower volume of intraoperative bleeding and fewer postoperative complications as compared with a conventional open liver resection, and considered to be safe and feasible treatment modality for liver tumors. Nutritional assessment is known to be important for predicting prognosis in patients with malignant diseases including HCC. Glasgow prognostic score (GPS) [4], defined based on C-reactive protein (CRP) (1.0 mg/dL) and serum albumin (3.5 g/dL) levels, has been shown to be an important and useful nutritional assessment tool for predicting prognosis in such cases [5–7]. Because HCC often develops in patients with chronic liver disease, mainly with liver cirrhosis, development of a new nutritional evaluation method, which fits for chronic liver disease patients, is needed
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
