Predicting Complications following Surgical Resection of Hepatocellular Carcinoma Using Newly Developed Neo-Glasgow Prognostic Score with ALBI Grade: Comparison of Open and Laparoscopic Surgery Cases

Simple Summary Glasgow prognostic score (GPS), using with CRP and albumin has been shown to be an important and useful nutritional assessment tool for predicting prognosis in such cases. We developed a modified GPS scoring method (neo-GPS), based on ALBI grade and reported to indicate the approximate borderline of amino acid imbalance instead of serum albumin, in the present study. The present results indicate that neo-GPS has not only better predictive value for prognosis but also shows greater sensitivity for predicting risk of postoperative complications as compared to GPS in patients undergoing a hepatectomy for hepatocellular carcinoma. Background/Aim: Nutritional assessment is known to be important for predicting prognosis in patients with malignant diseases. This study examined the usefulness of a prognostic predictive nutritional assessment tool for hepatocellular carcinoma (HCC) patients treated with surgical resection. Materials/Methods: HCC patients (n = 429) classified as Child-Pugh A who underwent an R0 resection between 2010 and 2020 were retrospectively analyzed (median age 73 years, males 326 (76.0%), Child-Pugh score 5:6 = 326:103, single tumor 340 (79.2%), median tumor size 3.5 cm, open:laparoscopic = 304:125). Glasgow prognostic score (GPS) and the newly developed neo-GPS method, which uses albumin-bilirubin grade 1 instead of albumin, were evaluated to compare their usefulness for prognosis prediction. Results: Median survival time for patients with a GPS score of 0, 1, and 2 was 120, 51, and 20 months, respectively. As for neo-GPS, that for those with a score of 0, 1, and 2 was not applicable (NA), 53 months, and 35 months, respectively (each p < 0.001; c-index: 0.556 and 0.611, respectively). Furthermore, median progression-free survival was 33, 22, and 9 months, and 41, 24, and 15 months, respectively (each p < 0.001; c-index: 0.539 and 0.578, respectively). As compared to patients with a high GPS (>= 1), those with a high neo-GPS (>= 1) showed a greater rate of high Clavien-Dindo classification (>= 3) (39.2% vs. 65.1%). A comparison of patients with a high GPS (>= 1) with those with a high neo-GPS (>= 1) showed no significant difference regarding frequency of open or laparoscopic hepatectomy (17.4% vs. 15.2%, p = 0.670; 44.7% vs. 43.2%, p = 0.831, respectively), while the frequency of high Clavien-Dindo classification (>= 3) was lower in patients who underwent a laparoscopic hepatectomy (11.2% vs. 22.7%, p = 0.007). Conclusion: The present findings suggest that the newly developed neo-GPS based on ALBI grade is an effective prognostic nutritional assessment tool and can be used for prediction of postoperative complications.

Automated summary

A modified Glasgow prognostic score (neo-GPS) based on ALBI grade was developed and found to be a more effective predictor for prognosis and risk of postoperative complications in hepatocellular carcinoma patients compared to the traditional GPS.