Background
Methods
Patients
Definition
Computation of scores and classifications
Variables | Score allocationb
| Total score | No. (% of total) | 6-month mortality (%) | Total score | No. (% of total) | 6-month mortality (%) |
---|---|---|---|---|---|---|---|
Diabetes mellitus | 1 | 0 | 36 (1.8) | 1 (2.8) | 6 | 203 (10.5) | 27 (13.3) |
Albumin ≤ 3.5 g/dL | 2 | 1 | 36 (1.8) | 2 (5.6) | 7 | 112 (5.7) | 21 (18.75) |
α-fetoprotein > 200 ng/mL | 2 | 2 | 532 (27.5) | 11 (2.1) | 8 | 76 (3.9) | 12 (15.8) |
Major resectionc
| 1 | 3 | 308 (15.9) | 10 (3.2) | 9 | 39 (2.0) | 9 (25.6) |
Blood loss > 800 mL | 1 | 4 | 288 (14.9) | 20 (6.9) | 10 | 6 (0.3) | 2 (33.3) |
Major surgical complicationsd
| 3 | 5 | 299 (15.5) | 30 (10) | Total | 1935 (100) | 145 (7.5) |
RAM scoree
| Score | 6-month mortality (%) | |||||
Class I | 0–6 | 101 (5.9) |
p < 0.001 | ||||
Class II |
7–9 | 42 (18.5) | |||||
Class III | 10 | 2 (33.3) |
Statistical analysis
Results
Patient demographics and operative variables
Variablesa
| No. (%) | Variablesa
| No. (%) |
---|---|---|---|
Gender (Male vs. Female) | 1511 (78.1) vs. 424 (21.9) | Surgical complications (major vs. minor/none)k
| 205 (10.6) vs. 1730 (89.4) |
HBVb surface antigen (Positive) | 1067 (55.2) | Daughter nodule (Yes) | 435 (22.5) |
Hepatitis C virus (Positive) | 568 (29.3) | Cirrhosis (Yes) | 984 (50.8) |
Non-B Non-Cc (Yes) | 248 (12.8) | Capsule (Yes) | 1552 (80.2) |
Child-Pugh Classification (A / B / C) | 1863 (96.3) / 27(1.4) / 1(0.1) | Rupture (Yes) | 143 (7.4) |
Comorbidity (Yes) | 739 (38.2) | Vascular invasion (Yes) | 693 (35.8) |
Diabetes Mellitus (Yes) | 405 (20.9) | Variablesa
| Median (IQR)p
|
Hypertension (Yes) | 434 (22.4) | Age (year-old) | 60 (50–69) |
ESRDd (Yes) | 38 (2.0) | ICG-15e (%) | 7.42 (4.07–12.56) |
Smoking (Yes) | 453 (23.4) | Albumin (g/dL) | 4.19 (3.80–4.40) |
Alcohol (Yes) | 294 (15.2) | Bilirubin total (mg/dL) | 0.7 (0.5–0.9) |
Age ≤ 65 (year-old) | 1264 (65.3) | Platelet (1000/uL) | 172 (129–216) |
ICG-15e ≤ 10 (%) | 1167 (60.3) | INRf
| 1.1 (1.0–1.1) |
Albumin > 3.50 (g/dL) | 1678 (86.7) | Creatinine (mg/dL) | 1.00 (0.81–1.20) |
Bilirubin total ≤ 2.0 (mg/dL) | 1894 (97.9) | Pre-OP CEAl (ng/mL) | 2.22 (1.35–3.38) |
Platelet > 100 (1000/uL) | 1688 (87.2) | Pre-OP CA-199m (U/mL) | 22.11 (10.63–37.73) |
INRf ≤ 1.4 | 1914 (98.9) | Pre-OP α-fetoproteinn (ng/mL) | 23.30 (5.49–328.28) |
Pre-OP treatmentg (Yes) | 189 (9.8) | Tumor size (cm) | 3.6 (2.4–6.5) |
Pre-OP symptomsh (Yes) | 496 (25.6) | OP durationo (minutes) | 254 (194–330) |
Inflow controli (Yes) | 1351 (69.8) | Blood loss (mL) | 300 (100–500) |
Procedure (Major resection(%))j
| 596 (30.8) |
Prediction of 6-month (early) mortality
Early Mortality vs. Lived |
P-value | Early recurrence vs. Non-recurrence |
P-value | ||
---|---|---|---|---|---|
RAM scorea (mean ± SE) | 5.52 ± 0.17 vs. 3.85 ± 0.05 | <0.001 | 4.34 ± 0.06 vs.3.35 ± 0.06 | <0.001 | |
ALBI scoreb (mean ± SE) | −2.47 ± 0.04 vs. -2.81 ± 0.01 | <0.001 | −2.71 ± 0.01 vs. -2.86 ± 0.01 | <0.001 | |
MELD scorec (mean ± SE) | 9.32 ± 0.33 vs. 8.27 ± 0.07 | 0.002 | 8.54 ± 0.09 vs. 8.23 ± 0.10 | 0.113 | |
Number (% of total) | Early mortality (6-month) (%) |
P-value | Early recurrence (2-year) (%) |
P-value | |
RAM scorea (n = 1935) | <0.001 | <0.001 | |||
RAM class I | 1702 (88) | 101 (5.9) | 887 (52.6%) | ||
RAM class II/III | 233 (12) | 48 (20.6) | 148 (68.2%) | ||
ALBI scoreb (n = 1892) | <0.001 | <0.001 | |||
ALBI grade 1 | 1341 (70.9) | 67 (5.0) | 666 (49.7%) | ||
ALBI grade 2 | 541 (28.6) | 75 (13.9) | 339 (62.7%) | ||
ALBI grade 3 | 10 (0.5) | 2 (20.0) | 7 (70.0%) | ||
MELD scorec (n = 1898) | 0.002 | 0.106 | |||
MELD grade 1 | 1513 (79.7) | 97 (6.4) | 799 (53.5%) | ||
MELD grade 2 | 319 (16.8) | 37 (11.6) | 183 (58.7%) | ||
MELD grade 3 | 66 (3.5) | 8 (12.1) | 28 (45.9%) |
Multivariate analysis | ||
---|---|---|
Hazard ratio (95% CI)j
|
P -value | |
Early Mortality | ||
RAM scorea
| ||
class II/III vs. class I | 2.847 (1.884~4.302) | <0.001 |
ALBI scoreb
| <0.001 | |
grade 2 vs. grade 1 | 2.309 (1.577~3.383) | <0.001 |
grade 3 vs. grade 1 | N/Ak
| 0.953 |
MELD scorec
| 0.271 | |
grade 2 vs. grade 1 | 1.218 (0.782~1.897) | 0.384 |
grade 3 vs. grade 1 | 1.873 (0.830~4.231) | 0.131 |
Alcohol consumption (Yes) | 1.799 (1.105~2.930) | 0.018 |
Cigarette smoking (Yes) | 1.110 (0.710~1.734) | 0.648 |
Age > 80 (year-old) | 1.988 (0.907~4.354) | 0.086 |
Pre-OP symptomsd (Yes) | 1.411 (0.956~2.083) | 0.083 |
Pre-OP treatmente (Yes) | 1.271 (0.765~2.111) | 0.355 |
Pre-OP platelets < 100 (1000/uL) | 1.453 (0.905~2.332) | 0.122 |
Pre-OP total bilirubin > 2.0 (mg/dL) | 1.377 (0.469~4.039) | 0.561 |
Pre-OP hemoglobin < 10 (g/dL) | 1.102 (0.596~2.038) | 0.756 |
ICG-15f > 10 (%) | 1.081 (0.740~1.580) | 0.687 |
OP durationg > 270 (mins) | 1.295 (0.875~1.915) | 0.196 |
Tumor size > 10 (cm) | 1.770 (1.130~2.771) | 0.013 |
Early Recurrence | ||
RAM scorea
| ||
class II/III vs. class I | 1.640 (1.352~1.988) | <0.001 |
ALBI scoreb
| 0.001 | |
grade 2 vs. grade 1 | 1.382 (1.190~1.606) | <0.001 |
grade 3 vs. grade 1 | 0.962 (0.301~3.077) | 0.948 |
MELD scorec
| 0.868 | |
grade 2 vs. grade 1 | 0.952 (0.787~1.150) | 0.608 |
grade 3 vs. grade 1 | 1.015 (0.683~1.509) | 0.941 |
Alcohol consumption (Yes) | 1.249 (1.003~1.557) | 0.047 |
Cigarette smoking (Yes) | 1.258 (1.057~1.498) | 0.010 |
Pre-OP symptomsd (Yes) | 1.006 (0.855~1.184) | 0.943 |
Pre-OP treatmente (Yes) | 1.183 (0.953~1.469) | 0.127 |
Pre-OP total bilirubin > 2.0 (mg/dL) | 1.513 (0.921~2.487) | 0.102 |
Pre-OP hemoglobin < 10 (g/dL) | 1.215 (0.903~1.634) | 0.199 |
Pre-OP ALTh > 40 (U/L) | 1.077 (0.940~1.234) | 0.284 |
ICG-15f > 10% | 1.347 (1.167~1.554) | <0.001 |
Tumor size > 10 (cm) | 1.773 (1.456~2.160) | <0.001 |
Inflow controli (Yes) | 1.162 (0.985~1.370) | 0.075 |