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Platelet-Albumin Score as a Sensitive Measure for Surgical Risk Prediction and Survival Outcomes of Patients with Hepatocellular Carcinoma

  • 2018 SSAT Plenary Presentation
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Given that patients with hepatocellular carcinoma (HCC) usually suffer from dual diseases (i.e., HCC and underlying liver disease), a complete survival estimation model is difficult to establish because both the oncological stage and the underlying liver function affect the survival outcome.

Methods

A new surgical risk model for estimating the survival of patients undergoing resection for HCC was created using a cohort treated between 1995 and 2013 (training set, n = 889), and its efficacy was then validated using a cohort treated between 2014 and 2017 (validation set, n = 310).

Results

The following statistical model was developed based on the results of multivariate analysis: albumin-platelet (PAL) score = − 0.777 × albumin (g/dL) − 0.575 × log10 (platelet count [104/μL]) (cut-off value, − 3.77 and − 3.04 for grading). A time-dependent receiver-operating curve analysis revealed that the area under the curve for 3-year survival was 0.644 in the training set and 0.666 in the validation set. The incidences of postoperative morbidity were 14.0% for PAL grade 1, 18.7% for PAL grade 2, and 26.1% for PAL grade 3 (P = 0.039), while the incidences of refractory ascites were 2.2, 7.1, and 12.5% (P = 0.005), respectively, in the training set. The reproducibility of these results was confirmed in the validation set with morbidity rates of 13.5, 23.3, and 40.7% (P = 0.003), respectively, and the incidences of refractory ascites were 0.7, 10.7, and 22.2% (P < 0.0001), respectively.

Conclusions

The PAL score can be used as a grading system for the stratification of survival outcomes and surgical risks of patients undergoing HCC resection.

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Funding

This study is supported by the institutional research grant for clinical study at Toranomon Hospital.

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Authors and Affiliations

  1. Hepatobiliary-pancreatic Surgery Division, Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan

    Junichi Shindoh, Yuta Kobayashi, Yoshitaka Kiya, Toshitaka Sugawara & Masaji Hashimoto

  2. Okinaka Memorial Institute for Medical Disease, Tokyo, Japan

    Junichi Shindoh

  3. Department of Hepatology, Toranomon Hospital, Tokyo, Japan

    Yusuke Kawamura, Norio Akuta, Masahiro Kobayashi, Yoshiyuki Suzuki & Kenji Ikeda

Authors
  1. Junichi Shindoh
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  2. Yusuke Kawamura
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  3. Yuta Kobayashi
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  4. Yoshitaka Kiya
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  5. Toshitaka Sugawara
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  7. Masahiro Kobayashi
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  8. Yoshiyuki Suzuki
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  10. Masaji Hashimoto
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Correspondence to Junichi Shindoh.

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Shindoh, J., Kawamura, Y., Kobayashi, Y. et al. Platelet-Albumin Score as a Sensitive Measure for Surgical Risk Prediction and Survival Outcomes of Patients with Hepatocellular Carcinoma. J Gastrointest Surg 23, 76–83 (2019). https://doi.org/10.1007/s11605-018-3871-1

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  • DOI: https://doi.org/10.1007/s11605-018-3871-1

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