Preoperative prealbumin level as an independent predictor of long-term prognosis after curative liver resection of hepatocellular carcinoma: a multicenter study of 1,483 patients

Abstract

Introduction: Serum prealbumin is more sensitive to profile nutritional status and liver function than albumin, which could hardly be affected by infusion supplement. This study aims to identify the relationship between preoperative prealbumin level and the long-term prognosis after curative resection of hepatocellular carcinoma (HCC). Methods: Patients undergone HCC curative resection between 2001 and 2014 at six institutions in China were enrolled. By using 170 mg/dl as cut-off value of serum prealbumin level, these patients were divided into the low and normal preoperative prealbumin groups. The overall survival (OS) and recurrence-free survival (RFS) were analyzed and compared. Univariable and multivariable Cox-regression analyses were performed to identify predictive factors of OS and RFS. Results: Among 1,483 patients, 437 (29.5%) had a low prealbumin level within a week before surgery. The 1-, 3-, and 5-year OS and RFS rates of patients in the low prealbumin group were 83.8%, 57.0%, and 31.1%, and 67.0%, 39.8%, and19.9%, respectively, which was significantly poorer than those in the normal group (93.0%, 75.5%, and 42.6%, and 77.0%, 56.4%, and 28.4%, both P < 0.001). Multivariable analyses revealed that preoperative prealbumin level, but not albumin level, was an independent predictor of OS (HR, 1.789; 95% CI: 1.544 -2.072, P < 0.001) and RFS (HR, 1.420; 95% CI: 232-1.636, P < 0.001). Conclusions: Preoperative prealbumin level is useful for predicting long-term prognosis in patients undergoing liver resection. Prealbumin may be suitable to displace albumin, yielding to an updated Child-Pugh grade for accessing liver function.