Assessment of Preoperative Liver Function in Patients with Hepatocellular Carcinoma - The Albumin-Indocyanine Green Evaluation (ALICE) Grade

被引：74

作者：

Kokudo, Takashi ^{[1
,2
,3
]}

Hasegawa, Kiyoshi ^{[1
,2
]}

Amikura, Katsumi ^{[3
]}

Uldry, Emilie ^{[4
]}

Shirata, Chikara ^{[1
,2
]}

Yamaguchi, Takamune ^{[1
,2
]}

Arita, Junichi ^{[1
,2
]}

Kaneko, Junichi ^{[1
,2
]}

Akamatsu, Nobuhisa ^{[1
,2
]}

Sakamoto, Yoshihiro ^{[1
,2
]}

Takahashi, Amane ^{[3
]}

Sakamoto, Hirohiko ^{[3
]}

Makuuchi, Masatoshi ^{[5
]}

Matsuyama, Yutaka ^{[6
]}

Demartines, Nicolas ^{[4
]}

Malago, Massimo ^{[7
]}

Kokudo, Norihiro ^{[1
,2
]}

Halkic, Nermin ^{[4
]}

机构：

[1] Univ Tokyo, Grad Sch Med, Dept Surg, Hepatobiliary Pancreat Surg Div, Tokyo, Japan

[2] Univ Tokyo, Grad Sch Med, Dept Surg, Artificial Organ & Transplantat Div, Tokyo, Japan

[3] Saitama Canc Ctr, Div Gastroenterol Surg, Saitama, Japan

[4] CHU Vaudois, Univ Hosp, Dept Visceral Surg, Lausanne, Switzerland

[5] Japanese Red Cross Med Ctr, Div Hepatobilliary Pancreat Surg, Tokyo, Japan

[6] Univ Tokyo, Sch Publ Hlth, Dept Biostat, Tokyo, Japan

[7] UCL, UCL Div Surg & Intervent Sci, Dept Surg, London, England

来源：

PLOS ONE | 2016年 / 11卷 / 07期

关键词：

PORTAL-HYPERTENSION; HEPATECTOMY; CIRRHOSIS; RESECTION; SURGERY;

D O I：

10.1371/journal.pone.0159530

中图分类号：

O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];

学科分类号：

07 ; 0710 ; 09 ;

摘要：

Background Most patients with hepatocellular carcinoma (HCC) have underlying liver disease, therefore, precise preoperative evaluation of the patient's liver function is essential for surgical decision making. Methods We developed a grading system incorporating only two variables, namely, the serum albumin level and the indocyanine green retention rate at 15 minutes (ICG R15), to assess the preoperative liver function, based on the overall survival of 1868 patients with HCC who underwent liver resection. We then tested the model in a European cohort (n = 70) and analyzed the predictive power for the postoperative short-term outcome. Results The Albumin-Indocyanine Green Evaluation (ALICE) grading system was developed in a randomly assigned training cohort: linear predictor = 0.663 x log(10)ICG R15 (%)-0.0718 x albumin (g/L) (cut-off value: -2.20 and -1.39). This new grading system showed a predictive power for the overall survival similar to the Child-Pugh grading system in the validation cohort. Determination of the ALICE grade in Child-Pugh A patients allowed further stratification of the postoperative prognosis. This result was reproducible in the European cohort. Determination of the ALICE grade allowed better prediction of the risk of postoperative liver failure and mortality (ascites: grade 1, 2.1%; grade 2, 6.5%; grade 3, 16.0%; mortality: grade 1, 0%; grade 2, 1.3%; grade 3, 5.3%) than the previously reported model based on the presence/absence of portal hypertension. Conclusions This new grading system is a simple method for prediction of the postoperative long-term and short-term outcomes.

引用

页数：15

共 22 条

[1] Portal Hypertension and the Outcome of Surgery for Hepatocellular Carcinoma in Compensated Cirrhosis: A Systematic Review and Meta-analysis [J].