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Erschienen in:
18.07.2018 | 2018 SSAT Plenary Presentation
Platelet-Albumin Score as a Sensitive Measure for Surgical Risk Prediction and Survival Outcomes of Patients with Hepatocellular Carcinoma
Erschienen in: Journal of Gastrointestinal Surgery | Ausgabe 1/2019
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Background
Given that patients with hepatocellular carcinoma (HCC) usually suffer from dual diseases (i.e., HCC and underlying liver disease), a complete survival estimation model is difficult to establish because both the oncological stage and the underlying liver function affect the survival outcome.
Methods
A new surgical risk model for estimating the survival of patients undergoing resection for HCC was created using a cohort treated between 1995 and 2013 (training set, n = 889), and its efficacy was then validated using a cohort treated between 2014 and 2017 (validation set, n = 310).
Results
The following statistical model was developed based on the results of multivariate analysis: albumin-platelet (PAL) score = − 0.777 × albumin (g/dL) − 0.575 × log10 (platelet count [104/μL]) (cut-off value, − 3.77 and − 3.04 for grading). A time-dependent receiver-operating curve analysis revealed that the area under the curve for 3-year survival was 0.644 in the training set and 0.666 in the validation set. The incidences of postoperative morbidity were 14.0% for PAL grade 1, 18.7% for PAL grade 2, and 26.1% for PAL grade 3 (P = 0.039), while the incidences of refractory ascites were 2.2, 7.1, and 12.5% (P = 0.005), respectively, in the training set. The reproducibility of these results was confirmed in the validation set with morbidity rates of 13.5, 23.3, and 40.7% (P = 0.003), respectively, and the incidences of refractory ascites were 0.7, 10.7, and 22.2% (P < 0.0001), respectively.
Conclusions
The PAL score can be used as a grading system for the stratification of survival outcomes and surgical risks of patients undergoing HCC resection.