Abstract
Background
This study aimed to develop a holistic risk score incorporating preoperative tumor,
liver, nutritional, and inflammatory markers to predict overall survival (OS) after
hepatectomy for hepatocellular carcinoma (HCC).
Methods
Patients who underwent curative-intent surgery for HCC between 2000 and 2020 were
identified using an international multi-institutional database. Preoperative predictors
associated with OS were selected and a prognostic risk score model (PreopScore) was
developed and validated using cross-validation.
Results
A total of 1676 patients were included. On multivariable analysis, preoperative parameters
associated with OS included α-feto protein (hazard ratio [HR]1.17, 95%CI 1.03–1.34),
neutrophil-to-lymphocyte ratio (HR2.62, 95%CI 1.30–5.30), albumin (HR0.49, 95%CI 0.34–0.70),
gamma-glutamyl transpeptidase (HR1.00, 95%CI 1.00–1.00), as well as vascular involvement
(HR3.52, 95%CI 2.10–5.89) and tumor burden score (medium, HR3.49, 95%CI 1.62–7.58;
high, HR3.21, 95%CI 1.40–7.35) on preoperative imaging. A weighted PreopScore was
devised and made available online (https://yutaka-endo.shinyapps.io/PrepoScore_Shiny/). Patients with a PreopScore 0–2, 2–3.5, and >3.5 had incrementally worse 5-year
OS of 85.8%, 70.7%, and 52.4%, respectively (p < 0.001). The c-index of the test and
validation cohort were 0.75 and 0.71, respectively. The PreopScore outperformed individual
parameters and previous HCC staging systems.
Discussion
The PreopScore can be used as a better guide to preoperatively identify patients and
individualize pre-/post-operative strategies.
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Article info
Publication history
Published online: January 06, 2023
Accepted:
December 31,
2022
Received:
June 27,
2022
Identification
Copyright
© 2023 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.
