The Combination of APRI and ALBI Facilitates Preoperative Risk Stratification for Patients Undergoing Liver Surgery After Neoadjuvant Chemotherapy

BackgroundNeoadjuvant chemotherapy (NeoCTx) is performed for most patients with colorectal cancer liver metastases (CRCLM). However, chemotherapy-associated liver injury (CALI) has been associated with poor postoperative outcome. To date, however, no clinically applicable and noninvasive tool exists to assess CALI before liver resection.MethodsRoutine blood parameters were assessed in 339 patients before and after completion of NeoCTx and before surgery. The study assessed the prognostic potential of the aspartate aminotransferase (AST)-to-platelet ratio index (APRI), the albumin-bilirubin grade (ALBI), and their combinations. Furthermore, an independent multi-center validation cohort (n=161) was included to confirm the findings concerning the prediction of postoperative outcome.ResultsHigher ALBI, APRI, and APRI+ALBI were found in patients with postoperative morbidity (P=0.001, P=0.064, P=0.001, respectively), liver dysfunction (LD) (P=0.009, P=0.012, P<0.001), or mortality (P=0.037, P=0.045, P=0.016), and APRI+ALBI had the highest predictive potential for LD (area under the curve [AUC], 0.695). An increase in APRI+ALBI was observed during NeoCTx (P<0.001). Patients with longer periods between NeoCTx and surgery showed a greater decrease in APRI+ALBI (P=0.006) and a trend for decreased CALI at surgery. A cutoff for APRI+ALBI at -2.46 before surgery was found to identify patients with CALI (P=0.002) and patients at risk for a prolonged hospital stay (P=0.001), intensive care (P<0.001), morbidity (P<0.001), LD (P<0.001), and mortality (P=0.021). Importantly, the study was able to confirm the predictive potential of APRI+ALBI for postoperative LD and mortality in a multicenter validation cohort.ConclusionDetermination of APRI+ALBI before surgery enables identification of high-risk patients for liver resection. The combined score seems to dynamically reflect CALI. Thus, APRI+ALBI could be a clinically relevant tool for optimizing timing of surgery in CRCLM patients after NeoCTx.