Journal
SURGERY TODAY
Volume 52, Issue 7, Pages 1096-1108Publisher
SPRINGER
DOI: 10.1007/s00595-021-02440-0
Keywords
Prognostic nutritional index; Aspartate aminotransferase-to-platelet ratio index; Prognosis; Hepatocellular carcinoma
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This study assessed the prognostic utility of inflammation-, nutrition-, and liver fibrosis-related markers in hepatocellular carcinoma patients. The results showed that the PNI-APRI score is a useful marker for predicting surgical outcomes in HCC patients, and it was confirmed in a validation cohort.
Purpose Inflammation-, nutrition-, and liver fibrosis-related markers are recognized as prognostic for hepatocellular carcinoma (HCC) patients. This study, therefore, assessed the preoperative prognostic utility of the combination of these markers in patients with HCC. Methods This single-center retrospective study included patients who underwent hepatic resection for HCC between 2004 and 2017. A total of 454 patients were divided into training (n = 334) and validation (n = 120) cohorts by random sampling. The predictive impact on surgical outcomes was evaluated using receiver operating characteristic (ROC) curves of these prognostic values in the training cohort. Results The prognostic nutritional index (PNI) and aspartate aminotransferase-to-platelet ratio index (APRI) were the strongest diagnostic values (areas under the ROC curves: 0.627 and 0.646, respectively). A scoring system (over 0-2 points) was developed using optimal cutoff values (for PNI < 46.5 scored as 1 point; for APRI > 0.98 scored as 1 point). An increased PNI-APRI score was an independent prognostic factor for both the overall and disease-free survival in HCC patients. Finally, the clinical feasibility of the PNI-APRI score was confirmed in the validation cohort. Conclusions The PNI-APRI score is a useful marker for predicting surgical outcomes of HCC patients.
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